Medicare AdvantagePrior AuthHigh impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Plastic Surgery, General Surgery, Gastroenterology +3 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 25, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia will require prior authorization/precertification through Carelon Medical Benefits Management for 66 new billing codes spanning autologous skin grafts, esophageal procedures, neurostimulator devices, and advanced wound care products. Billing teams must update systems to require prior authorization for these codes before the effective date to prevent claim denials.
Action Required
By December 31, 2026: Billing team must update billing software and systems to require prior authorization through Carelon Medical Benefits Management for all 66 affected codes listed above when billing Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia. Update encounter forms, templates, and provider documentation workflows to include alerts for these codes. Train front desk and clinical staff to flag these procedures during scheduling so that prior authorization can be obtained before the service date. Failure to obtain prior authorization will result in claim denials for dates of service on or after January 1, 2027.