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[New York] National accounts: 2027 standard prior authorization requirements
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026
Summary
Effective January 1, 2027, Anthem is implementing comprehensive prior authorization requirements for National accounts in New York across inpatient admissions, advanced diagnostic testing, specialized DME/prosthetics, transplants, gene therapy, mental health services, and numerous surgical/outpatient procedures. Billing teams must update systems to require pre-certification for these services before claim submission to avoid denials.
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What to do
by Dec 31, 2026 · 5 steps
01Billing team must update billing software and prior authorization workflows to require pre-certification for all listed services effective January 1, 2027.
02Update encounter forms and clinical templates to prompt providers to obtain pre-authorization for: inpatient admissions (acute, rehab, LTACH, SNF, OB deliveries beyond federal mandate), all genetic and chromosomal testing, advanced DME devices (AAC devices, brain-computer interfaces, compression devices, FES/TES, robotic systems, powered exoskeletons, etc.), gender-affirming surgery, all solid organ and bone marrow/stem cell transplants, CAR T-cell therapies, gene replacement therapies, mental health/substance abuse services (acute inpatient, TMS, residential care, in-home behavioral programs, ABA, IOP, PHP), and extensive outpatient surgical services (bariatric surgery, cardiac procedures, implantable devices, cosmetic/reconstructive procedures, etc.).
03Note: Emergency inpatient admissions do not require pre-certification but plan notification must be provided as soon as possible.
04Failure to obtain required prior authorization will result in claim denials.
05Providers should reference the complete policy list when preparing cases.
Original notice
[New York] National accounts: 2027 standard prior authorization requirements
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider Bulletin[Ohio] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider Bulletin[New York] Precertification/prior authorization requirement changesMediumEffective Jan 1, 2027 · Provider Bulletin[New York] Prior authorization requirement changesMediumEffective Sep 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list