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Anthem BCBSMedicare Advantage · Administrative · Provider Bulletin · GA · Cardiology, GastroenterologyMedium impact

[Georgia] Carelon Medical Benefits Management updates

Effective date
Nov 15, 2026
Identified
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.

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What to do

Action · 4 steps
01Before 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.
02Access guidelines via the Anthem provider portal at the URL provided.
03No immediate workflow changes are required, but remain alert for a separate notice that may announce new prior authorization requirements for these services.
04Update internal references and staff training materials once guidelines are published.

Original notice

[Georgia] Carelon Medical Benefits Management updates
providernews.anthem.com · Always check the source before changing claims.
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Related changes

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[New York] Carelon Medical Benefits Management updatesMediumEffective Nov 15, 2026 · Provider Bulletin[Virginia] Carelon Medical Benefits Management updatesMediumEffective Nov 15, 2026 · Provider Bulletin[California] Carelon Medical Benefits Management updatesMediumEffective Sep 28, 2026 · Provider Bulletin[Ohio] Carelon Medical Benefits Management updatesMediumEffective Nov 28, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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