CommercialPrior AuthMedium impact
[Ohio] Precertification/prior authorization list change notification
Anthem BCBS·OH · Neurology, Gastroenterology, Infectious Disease +5 more·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Jul 7, 2026
Summary
Anthem Blue Cross and Blue Shield (Ohio) is adding 14 new services to its precertification/prior authorization requirements effective December 1, 2026. These additions include four specialized laboratory tests (Alzheimer's biomarkers, IBS serology, infectious disease sequencing, prostate cancer protein biomarkers), two irreversible electroporation procedures, six carotid sinus baroreceptor stimulation device codes, and two gene therapy treatments. All affected services will require prior authorization before billing to avoid claim denials.
Action Required
By November 15, 2026: Billing team must update the billing system and prior authorization workflows to require precertification for all 16 affected codes (0596U, 0598U, 0600U, 0609U, 47384, 55877, 64654-64659, 93145, 93146, J3387, J3389). Update encounter forms and provider templates to remind ordering clinicians of the prior authorization requirement for these services. Verify member eligibility and benefits through Availity Essentials before scheduling or billing. Establish internal tracking to ensure all claims for these codes include prior authorization approval before submission. Effective December 1, 2026, claims submitted without required prior authorization will be deemed ineligible for payment and subject to denial. Train all billing staff, front desk personnel, and providers on the new requirements. Maintain documentation of all prior authorization requests and approvals in patient records.