CommercialPrior AuthHigh impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)
Anthem BCBS·OH · Cardiology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
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.
Action Required
By November 1, 2026: Billing 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. Identify which CPT/HCPCS codes now require prior authorization under Carelon. Update billing system rules and encounter templates to mandate precertification for affected codes before December 1, 2026. Notify all providers in these specialties of new prior auth requirements. Failure to obtain required prior authorization will result in claim denials.