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[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (August 2026 Newsletter)
Effective date
Oct 1, 2026
Identified
Jul 29, 2026
Summary
Carelon Medical Benefits Management has issued multiple prior authorization requirement updates across multiple service categories (Genetic Testing, Surgical, DME/POS, Cardiology, Radiation Therapy, Sleep, Radiation Oncology, and Cardiovascular services) effective at staggered dates between October 1, 2026 and December 1, 2026. These are material amendments to contract terms affecting Commercial, Medicare Advantage, Medicaid, and MyCare Ohio plans in Ohio. The practice must review detailed policy documents for each specialty to identify specific code-level changes and implement corresponding prior authorization workflows.
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What to do
Action · 7 steps
01IMMEDIATE ACTION REQUIRED: By September 15, 2026 (before first effective date of October 1, 2026).
02Billing team and clinical leadership must access the full policy documents via the Anthem provider portal (https://providernews.anthem.com/ohio) for each affected specialty category listed: Genetic Testing, Surgical, DME/POS, Cardiology, Radiation Therapy, Sleep, Radiation Oncology, and Cardiovascular.
03Extract specific CPT/HCPCS codes affected by each update and identify which prior authorization thresholds or requirements have changed.
04Update billing software and EMR systems to enforce new prior authorization requirements for each affected code.
05Create or modify encounter templates and charge capture workflows to require documentation of prior authorization status before claim submission.
06Alert all providers and clinical staff in these specialties about new requirements, particularly noting staggered effective dates (October 1, December 1, November 1 vary by service line and plan type).
07Implement monitoring process to track compliance with new prior auth requirements.
If missed: Failure to obtain required prior authorizations before service delivery will result in claim denials under these updated policies.
Original notice
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (August 2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] Prior authorization requirement changes (October 2026 Newsletter)HighEffective Jan 1, 2027 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (October 2026 Newsletter)HighEffective Jan 1, 2027 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)MediumEffective Dec 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)MediumEffective Dec 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list