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[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)
Act
by Nov 1, 2026
Effective date
Dec 1, 2026
Identified
Aug 29, 2026
Summary
Carelon Medical Benefits Management (Ohio) is updating prior authorization requirements across three service categories: Additional Outpatient, Cardiovascular, and unspecified other services, effective December 1, 2026. The specific requirement changes are not detailed in this bulletin summary, but the full policy documents are referenced and must be reviewed to determine which procedures now require precertification.
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What to do
by Nov 1, 2026 · 4 steps
01Billing team must access and review the full policy documents for Additional Outpatient (effective August 5, 2026), Cardiovascular (effective August 12, 2026), and related service categories at https://providernews.anthem.com/ohio/articles/precertificationprior-authorization-requirement-updates-care-31996.
02Identify which CPT/HCPCS codes now require prior authorization under Carelon.
03Update billing system rules and encounter templates to mandate precertification for affected codes before December 1, 2026.
04Notify all providers in these specialties of new prior auth requirements.
If missed: Failure to obtain required prior authorization will result in claim denials.
Original notice
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
Related changes
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