CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (August 2026 Newsletter)
Anthem BCBS·NY · Genetics, Orthopedics, General Surgery +3 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 30, 2026
Summary
Carelon Medical Benefits Management has updated prior authorization requirements across multiple service categories effective November 1, 2026 (December 1 for Radiation Therapy). Changes affect Genetic Testing, Musculoskeletal, Surgical, DME/POS, Cardiology, Radiology, and Radiation Therapy services across Commercial, Medicare Advantage, and Medicaid plans in New York. The policy document references updated guidelines but specific authorization requirement changes are not detailed in this newsletter announcement.
Action Required
By October 15, 2026: Billing team must obtain and review the detailed prior authorization updates for each affected service category (Genetic Testing, Musculoskeletal, Surgical, DME/POS, Cardiology, Radiology, and Radiation Therapy) from Carelon Medical Benefits Management. Update billing system logic and provider encounter forms to reflect new prior authorization triggers and requirements. Contact Carelon directly or visit their provider portal to download complete updated guidelines for each specialty. Communicate changes to clinical staff and ensure all relevant departments understand new authorization workflows by November 1, 2026 effective date (December 1 for Radiation Therapy). Failure to follow updated authorization requirements will result in claim denials.