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Anthem BCBSMedicaid · Administrative · Provider Bulletin · CA · Cardiology, Radiology, Sleep Medicine +4 moreMedium impact

[California] Carelon Medical Benefits Management updates

Act
by Nov 28, 2026
Effective date
Nov 28, 2026
Identified
Aug 29, 2026

Summary

Carelon Medical Benefits Management has updated clinical appropriateness guidelines for Anthem Blue Cross Medi-Cal Managed Care, effective November 28, 2026. Guidelines have been reorganized and consolidated across radiology, cardiovascular, sleep, genetic testing, and prenatal screening categories. Existing prior authorization requirements remain unchanged, and no new prior auth requirements are being implemented at this time.

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What to do

by Nov 28, 2026 · 5 steps
01Billing and clinical staff should review updated Carelon Medical Benefits Management guidelines published September 19, 2026 for radiology (brain, extremities, heart, spine, vascular imaging), cardiovascular services (cardiac devices, coronary angiography, percutaneous coronary intervention, wearable defibrillators, transcatheter ablation), sleep disorder management, genetic testing, and prenatal cell-free DNA screening.
02Download current and updated guidelines from the provider portal at https://providernews.anthem.com/california/articles/carelon-medical-benefits-management-updates-31865.
03Ensure all providers and office staff are notified of guideline changes.
04No immediate billing system changes are required; however, monitor for future separate notice if new prior authorization requirements are implemented.
05Update clinical documentation practices to align with consolidated guideline formats.

Original notice

[California] 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[California] Carelon Medical Benefits Management updatesMediumEffective Sep 28, 2026 · Provider Bulletin[Ohio] Carelon Medical Benefits Management updatesMediumEffective Nov 28, 2026 · Provider Bulletin[California] Carelon Medical Benefits Management updatesMediumEffective Oct 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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