Medicare AdvantagePrior AuthHigh impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · 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 Ohio now require prior authorization/precertification through Carelon Medical Benefits Management for 15 DMEPOS codes related to lumbar-sacral orthoses, knee orthoses, ankle-foot orthoses, and one prosthetic device. Ordering and servicing providers must submit authorization requests via the Carelon provider portal or Availity before dispensing these items.
Action Required
By October 1, 2026: Billing team must implement prior authorization requirements for all 16 affected DMEPOS codes (L0631, L0637, L0639, L0648, L0650, L0651, L1832, L1843, L1844, L1845, L1846, L1851, L1852, L1932, L1951, L5980) in the billing system for Anthem Blue Cross and Blue Shield Medicare Advantage patients in Ohio. Update workflow to require precertification submission to Carelon Medical Benefits Management via the provider portal (https://providerportal.com) or Availity (https://Availity.com) BEFORE dispensing orthotic and prosthetic devices. Notify all ordering providers, DME suppliers, and orthotists of the new requirement and submission methods. Configure billing system to flag these codes and prevent claim submission without documented prior authorization. Failure to obtain prior authorization will result in claim denials for dates of service on or after November 1, 2026.