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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · OH · General Surgery, Cardiothoracic Surgery, Vascular Surgery +2 moreHigh impact

[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (October 2026 Newsletter)

Act
by Dec 15, 2026
Effective date
Jan 1, 2027
Identified
Oct 1, 2026

Summary

Carelon Medical Benefits Management (Anthem Blue Cross and Blue Shield in Ohio) has issued updated prior authorization/precertification requirements for surgical procedures. Multiple effective dates are outlined: January 1, 2027 for Base Surgical (both Commercial and Medicare Advantage) and February 1, 2027 for Surgical SOCs (Commercial). The specific authorization requirement changes are not detailed in this summary document and require review of the full policy links provided.

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What to do

by Dec 15, 2026 · 4 steps
01Billing team must access the complete policy documents via the Anthem provider portal (https://providernews.anthem.com/ohio/articles/precertificationprior-authorization-requirement-updates-care-32609) to identify specific surgical procedures and CPT codes affected by the prior authorization changes.
02Update billing system rules and EMR templates to reflect new authorization requirements for Anthem Commercial and Medicare Advantage plans in Ohio effective January 1, 2027.
03For Commercial Surgical SOCs, implement changes by January 15, 2027 for the February 1, 2027 effective date.
04Notify all surgical staff and providers of changes.
If missed: Failure to obtain required prior authorizations will result in claim denials.

Original notice

[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (October 2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[Ohio] Prior authorization requirement changes (October ​2026 Newsletter)HighEffective Jan 1, 2027 · Provider Bulletin[Ohio] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider Bulletin[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (October 2026 Newsletter)HighEffective Jan 1, 2027 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesOH policy changesGeneral SurgeryCardiothoracic SurgeryVascular SurgeryBariatric SurgeryPlastic Surgery

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