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[Georgia] Medical Policies and Clinical Utilization Management Guidelines update
Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Sep 29, 2026
Summary
Anthem Blue Cross and Blue Shield (Georgia) is implementing 28 new and revised Medical Policies and Clinical Utilization Management Guidelines effective November 1, 2026. These changes span multiple service categories including gene therapies, surgical procedures, imaging, rehabilitation, and transplantation. Some revisions may result in previously covered services being determined as not medically necessary, requiring immediate review of affected service lines.
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What to do
by Oct 31, 2026 · 6 steps
01Billing and clinical teams must obtain and review all 28 updated policies from Anthem's Medical Policies & Clinical UM Guidelines website (listed by policy number: ADMIN.00009, DME.00056, LAB.00046, MED.00135, MED.00140, MED.00149, MED.00161, MED.00164, MED.00165, MED.00166, SURG.00023, SURG.00026, CG-DME-44, CG-LAB-38, CG-MED-69, CG-MED-99, CG-MED-107, CG-RAD-33, CG-REHAB-02, CG-REHAB-03, CG-SURG-24, CG-SURG-51, CG-SURG-81, CG-SURG-134, CG-SURG-135, CG-TRANS-02).
02Identify which policies affect your practice's service lines.
03For each affected policy, update billing workflows, prior authorization requirements, and encounter templates accordingly.
04Notify all clinical staff and providers of coverage changes.
05Update billing system rules to reflect new medical necessity criteria.
06Before November 1, 2026: Test all system changes in a non-production environment.
If missed: Failure to implement these changes may result in claims denials for services that are no longer covered or require prior authorization.
Original notice
[Georgia] Medical Policies and Clinical Utilization Management Guidelines update
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Georgia] Medical Policy and Clinical Guideline updatesHighEffective Oct 1, 2026 · Medical Policy[California] Medical Policies and Clinical Utilization Management Guidelines updateHighEffective Nov 1, 2026 · Prior Authorization[New York] Medical Policies and Clinical Utilization Management Guidelines updateHighEffective Nov 1, 2026 · Prior Authorization[Ohio] Medical Policies and Clinical Utilization Management Guidelines updateHighEffective Jan 1, 2027 · Prior AuthorizationBrowse every Anthem BCBS change in the policy list