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

[New York] Carelon Medical Benefits Management updates

Effective date
Nov 15, 2026
Identified
Aug 29, 2026

Summary

Anthem Blue Cross and Blue Shield is transitioning to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective November 15, 2026, for two procedures: Cardiovascular Catheter-Based Closure of Patent Foramen Ovale and Surgical Upper Gastrointestinal Endoscopy. Existing prior authorization requirements remain unchanged, and any new prior auth requirements will be communicated separately in advance.

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What to do

Action · 4 steps
01Before November 15, 2026: Billing team and clinical staff should download and review the updated Carelon Medical Benefits Management Clinical Appropriateness Guidelines for Cardiovascular Catheter-Based Closure of Patent Foramen Ovale and Surgical Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy) from the provided resource link.
02No immediate billing system changes are required at this time, as existing prior authorization requirements have not changed.
03Monitor for a separate notice regarding any new prior authorization requirements that may be implemented after the effective date.
04Distribute this notice to all relevant practice members and office staff.

Original notice

[New York] Carelon Medical Benefits Management updates
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

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

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Anthem BCBS policiesNY policy changesCardiologyGastroenterology

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