Medicare AdvantageAdministrativeMedium impact
[Georgia] Carelon Medical Benefits Management updates
Anthem BCBS·GA · Cardiology, Gastroenterology·Provider Bulletin
Effective date
Nov 15, 2026
We identified it
Aug 29, 2026
Summary
Anthem Blue Cross Blue Shield (Georgia) is transitioning to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective November 15, 2026. Two procedures are affected: Cardiovascular Catheter-Based Closure of Patent Foramen Ovale and Surgical Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy). Existing prior authorization requirements remain unchanged, but providers should monitor for future prior auth implementation notices.
Action Required
Before November 15, 2026: Billing and clinical staff should review the updated Carelon Medical Benefits Management Clinical Appropriateness Guidelines for Cardiovascular Catheter-Based Closure of Patent Foramen Ovale and Surgical Upper Gastrointestinal Endoscopy procedures. Access guidelines via the Anthem provider portal at the URL provided. No immediate workflow changes are required, but remain alert for a separate notice that may announce new prior authorization requirements for these services. Update internal references and staff training materials once guidelines are published.