Medicare AdvantagePrior AuthHigh impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Cardiology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 15, 2026
Summary
Effective November 1, 2026, four echocardiography CPT codes (93320, 93321, 93325, 93352) now require precertification/prior authorization through Carelon Medical Benefits Management for all Anthem FIDE (Fully Integrated Dual Eligible) plans in Ohio. Billing teams must implement prior auth workflows for these cardiology procedures to avoid claim denials.
Action Required
By October 1, 2026: Billing team must update billing system to require prior authorization for CPT codes 93320, 93321, 93325, and 93352 when billed to Anthem FIDE plans in Ohio. Providers and cardiology staff must be notified to submit precertification requests via Carelon provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before scheduling or performing these echocardiography procedures. Update encounter forms and EMR templates to flag these codes for prior auth requirement. Claims submitted without prior authorization will be denied. Contact Carelon Medical Benefits Management at MedicalBenefitsManagement.guidelines@Carelon.com for guideline questions.