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CommercialPrior AuthMedium impact

[Ohio] Prior authorizations for genetic testing care services

Anthem BCBS·OH · Genetics, OB-GYN·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jul 21, 2026
Days to comply

Summary

Effective July 1, 2026, Anthem Blue Cross and Blue Shield in Ohio is consolidating prior authorization for genetic testing services (specifically pre-implantation embryo genetic testing) under Carelon Medical Benefits Management. Providers must submit all genetic testing reviews exclusively to Carelon instead of Anthem, streamlining the review process into a single entity.

Action Required

Action needed
By June 30, 2026: Billing and authorization staff must transition all genetic testing prior authorization submissions from Anthem Blue Cross and Blue Shield to Carelon Medical Benefits Management. Update internal workflows, provider portals, and authorization checklists to direct all pre-implantation embryo genetic testing reviews to Carelon Medical Benefits Management Provider Services (https://www.providerportal.com). Verify that Carelon contact information is current in billing system templates and staff training materials. Failure to route authorization requests to Carelon will result in processing delays and potential claim denials for affected groups enrolled in the Carelon genetic testing program.