CommercialPrior AuthMedium impact
[Ohio] Precertification/prior authorization list change notification
Anthem BCBS·OH · Hematology, Oncology, Genetics +2 more·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Jul 28, 2026
Summary
Anthem Blue Cross and Blue Shield (Ohio) is adding 12 new services to its prior authorization/precertification requirements, effective December 1, 2026. These include 5 gene therapy procedures and 7 hematopoietic stem cell transplantation procedures for various conditions. Billing teams must obtain prior authorization before providing these services or claims will be denied.
Action Required
By November 15, 2026: Billing team must update the prior authorization requirements matrix in the billing system to flag all services matching criteria MED.00140, MED.00142, MED.00146, MED.00148, MED.00161, TRANS.00023, TRANS.00024, TRANS.00027, TRANS.00028, TRANS.00029, TRANS.00030, TRANS.00031, and TRANS.00034 as requiring prior authorization from Anthem Blue Cross and Blue Shield for Ohio commercial members. Update encounter forms and clinical workflows to require providers to request prior authorization through Availity Essentials before scheduling or performing any gene therapy or hematopoietic stem cell transplantation procedures. Train billing staff and providers on the new requirements. Failure to obtain prior authorization will result in claim denials. Reference the Anthem provider bulletin (https://providernews.anthem.com/ohio/articles/precertificationprior-authorization-list-change-notification-31304) for complete details on each criterion.