CommercialPrior AuthMedium impact
[New York] Prior authorizations for genetic testing care services
Anthem BCBS·NY · Genetics, OB-GYN·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jul 21, 2026
Summary
Effective July 1, 2026, Anthem Blue Cross and Blue Shield is consolidating prior authorization for genetic testing services (specifically pre-implantation embryo genetic testing) under Carelon Medical Benefits Management for participating New York groups. Providers must submit all genetic testing prior authorization requests exclusively to Carelon Medical Benefits Management instead of to Anthem directly. This streamlines the review process through a single entity.
Action Required
By July 1, 2026: Billing and clinical staff must update all prior authorization submission workflows for genetic testing services. Specifically: (1) Redirect all genetic testing prior authorization requests to Carelon Medical Benefits Management via their provider portal at https://www.providerportal.com instead of submitting to Anthem; (2) Update internal templates, protocols, and staff training materials to reflect the new submission pathway; (3) Verify all affected patient accounts and groups are enrolled in the Carelon Medical Benefits Management genetic testing program; (4) Contact Carelon Medical Benefits Management Provider Services with any questions about submission procedures. Failure to submit prior authorizations to the correct entity may result in claim denials or processing delays.