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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · OHHigh impact

[Ohio] Prior authorization requirement changes (October ​2026 Newsletter)

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026

Summary

Anthem Blue Cross and Blue Shield has announced changes to prior authorization requirements for Medicare Advantage and Ohio Medicaid Managed Care plans, effective January 1, 2027. The specific details of which services or procedures are affected are not provided in this bulletin excerpt—billing teams must access the full policy documents via the provided links to identify impacted codes and workflows.

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What to do

by Dec 31, 2026 · 6 steps
01Billing team must obtain and review the complete prior authorization requirement change documents from Anthem for both Medicare Advantage (dated September 18, 2026) and Ohio Medicaid Managed Care (dated September 28, 2026) via https://providernews.anthem.com/ohio/articles/prior-authorization-requirement-changes-october-2026-newslet-32617.
02Once specific codes are identified.
03Update billing system rules and denial management software to enforce new prior auth requirements.
04Revise pre-authorization checklists and provider encounter templates.
05Brief clinical staff and coders on which services now require authorization.
06Test billing workflows with at least 5 sample claims before January 1, 2027.
If missed: Failure to implement these changes will result in claim denials for services that newly require prior authorization.

Original notice

[Ohio] Prior authorization requirement changes (October ​2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
View original ↗

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