Medicare AdvantagePrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Infectious Disease, Wound Care, General Surgery·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 15, 2026
Summary
Effective November 1, 2026, CPT code 0600U (FidaLab Molecular Wound Infection Test) now requires precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage members in Ohio. Ordering and servicing providers must submit prior auth requests via the Carelon provider portal, Availity Essentials, or email before performing this test.
Action Required
By November 1, 2026: Billing and clinical staff must implement prior authorization requirement for CPT 0600U before ordering or processing claims for Anthem Blue Cross and Blue Shield Medicare Advantage members in Ohio. Providers must: (1) Update billing system to flag CPT 0600U for prior auth requirement; (2) Train ordering providers to obtain precertification before test requisition; (3) Establish workflow to submit requests via Carelon provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com); (4) Document prior auth approval number before claim submission. Failure to obtain prior authorization will result in claim denials. Contact Carelon Medical Benefits Management at MedicalBenefitsManagement.guidelines@Carelon.com for guideline questions. Reference UM AROW #: M6039.