[Georgia] Site of Care Program for surgical procedures expansion

By October 15, 2026: Billing and authorization teams must implement prior authorization workflow changes for all surgical procedures scheduled at outpatient hospital settings for Anthem commercial plans in Georgia. Update authorization system to route outpatient hospital surgical cases for site of care clinical appropriateness review in addition to standard medical necessity review. Train front desk and scheduling staff to identify procedures being scheduled at outpatient hospital facilities versus ASCs. Update pre-authorization submission processes to include site of care documentation justifying why outpatient hospital setting is clinically necessary rather than ASC. Failure to obtain site of care prior authorization for outpatient hospital surgical procedures will result in claim denials. Direct questions to Carelon Medical Benefits Management via Availity Chat during business hours or use provider contact resources at https://providers.carelonmedicalbenefitsmanagement.com/surgicalprocedures/resources/.