CommercialPrior AuthMedium impact
[California] Prior authorizations for genetic testing care services
Anthem BCBS·CA · Genetics, OB-GYN·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jul 21, 2026
Summary
Effective July 1, 2026, Anthem Blue Cross is consolidating prior authorization for genetic testing services (specifically pre-implantation embryo genetic testing) under Carelon Medical Benefits Management for Commercial groups that selected this program. Providers must now submit all genetic testing prior authorization requests exclusively to Carelon Medical Benefits Management instead of Anthem Blue Cross, streamlining the review process through a single entity.
Action Required
By June 30, 2026: Billing and clinical staff must identify all Anthem Blue Cross Commercial patients with Carelon genetic testing program coverage. Update internal prior authorization routing procedures to submit genetic testing reviews (particularly pre-implantation embryo genetic testing) exclusively to Carelon Medical Benefits Management via https://www.providerportal.com instead of Anthem Blue Cross. Update billing software, encounter templates, and provider instructions to reflect the new submission pathway. Ensure prior authorization requests are directed to Carelon Medical Benefits Management Provider Services for all affected groups. Failure to route requests correctly may delay authorization and potentially impact claim processing.