MedicaidAdministrativeMedium impact
[California] Carelon Medical Benefits Management updates
Anthem BCBS·CA · Cardiology, Radiology, Sleep Medicine +4 more·Provider Bulletin
Effective date
Nov 28, 2026
We identified it
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.
Action Required
By November 28, 2026: Billing 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. Download current and updated guidelines from the provider portal at https://providernews.anthem.com/california/articles/carelon-medical-benefits-management-updates-31865. Ensure all providers and office staff are notified of guideline changes. No immediate billing system changes are required; however, monitor for future separate notice if new prior authorization requirements are implemented. Update clinical documentation practices to align with consolidated guideline formats.