[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

Before December 1, 2026: (1) Billing team and providers must update internal systems and workflows to require prior authorization for CPT 1020T through Carelon Medical Benefits Management. (2) Register/verify access to Carelon provider portal at https://providerportal.com or Availity Essentials at https://Availity.com for submitting authorization requests in real-time. (3) Update encounter forms, order templates, and billing software decision rules to flag CPT 1020T for mandatory precertification. (4) Communicate to dermatology and relevant clinical staff that this procedure cannot be billed without prior authorization approval. (5) Establish process to capture and document authorization numbers before claim submission. Claims for CPT 1020T submitted without Carelon precertification approval will be denied by Anthem Blue Cross and Blue Shield Commercial plans in New York.