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[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Act
by Oct 1, 2026 (30 days before effective date)
Effective date
Nov 1, 2026
Identified
Jul 15, 2026
Summary
Effective November 1, 2026, Carelon Medical Benefits Management is adding 13 new CPT and HCPCS codes across sleep medicine, radiation oncology, radiology, and cardiovascular specialties to the precertification/prior authorization requirement for all Ohio FIDE (Fully Integrated Dual Eligible) plans. Providers must obtain prior authorization before delivering these services or face potential claim denials.
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What to do
by Oct 1, 2026 (30 days before effective date) · 5 steps
01Billing team and providers must update billing software, EMR systems, and prior authorization workflows to require precertification through Carelon Medical Benefits Management for all 12 affected codes (64568, C1607, 77402, 77407, 77412, 70471, 70473, A9616, C7568, C7569, C7570, C7571).
02Configure system alerts and encounter forms to prompt providers to submit prior auth requests before scheduling or performing procedures.
03Staff should be trained on submission methods: Carelon provider portal (https://providerportal.com - available 24/7) or Availity Essentials (https://Availity.com).
04For MyCare Ohio (Ohio FIDE plans only): Route all prior auth requests to Carelon Medical Benefits Management.
05Claims submitted without required prior authorization will be denied.
Codes mentioned
64568C16077740277407774127047170473A9616C7568C7569C7570C7571
Original notice
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Jul 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Jul 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Jul 1, 2026 · Provider Bulletin[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list