Medicare AdvantagePrior AuthHigh impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab) +2 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 8, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia will require prior authorization/precertification through Carelon Medical Benefits Management for 14 specific DMEPOS orthotic and prosthetic codes (lumbar-sacral orthoses, knee orthoses, ankle-foot orthoses, and one prosthetic code). Ordering and servicing providers must submit authorization requests via Carelon's provider portal, Availity, or email before dispensing these items to avoid claim denials.
Action Required
By October 31, 2026: Billing team and ordering providers must implement prior authorization requirement for all claims with DMEPOS codes L0631, L0637, L0639, L0648, L0650, L0651, L1832, L1843, L1844, L1845, L1846, L1851, L1852, L1932, L1951, and L5980 submitted to Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia. (1) Update billing software and claim submission workflows to automatically require and route prior authorization through Carelon Medical Benefits Management before processing these codes. (2) Register ordering and servicing providers on Carelon's provider portal (https://providerportal.com) or Availity (https://Availity.com) to enable real-time authorization requests. (3) Educate clinical and front-desk staff that these orthotic/prosthetic items cannot be dispensed until prior authorization is obtained. (4) Establish internal process to track and document all authorization requests and approvals for compliance. Claims submitted without prior authorization will be denied. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for guideline questions.