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[Georgia] Clinical Criteria updates
Act
by Nov 29, 2026
Effective date
Nov 29, 2026
Identified
Oct 25, 2026
Summary
Anthem Blue Cross and Blue Shield has revised 60 clinical criteria policies for medical drug benefits effective November 29, 2026. These revised criteria apply to Medicare Advantage members in Georgia and affect medical necessity requirements for a broad range of specialty drugs including biologics, oncology agents, and rare disease treatments. Billing teams must verify current authorization requirements through separate notices, as this bulletin informs of criteria changes but does not detail authorization procedures.
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What to do
by Nov 29, 2026 · 4 steps
01Billing team and clinical staff should access Anthem's Clinical Criteria page to review the full text of all 60 revised criteria (CC-0001 through CC-0310) applicable to the medical drug benefit for Medicare Advantage members.
02Staff should cross-reference the revised criteria with current authorization protocols, as the source states that authorization rules are communicated separately and this notice does not include authorization requirement details.
03Verify whether the practice's billing system, prior authorization workflows, and clinical documentation processes align with the November 29, 2026 effective date.
04Distribute this notice to all practice members and office staff who handle Medicare Advantage claims or prior authorizations for the affected drug classes.
Original notice
[Georgia] Clinical Criteria updates
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Georgia] 2027 Medicare formulary changes: Prepare now forHighEffective Jan 1, 2027 · Pharmacy[Georgia] New prior authorization requirementsMediumEffective Jan 1, 2027 · Provider Bulletin[New York] Clinical Criteria updates (November 2026 Newsletter)MediumNo effective date · Provider Bulletin[Virginia] Clinical Criteria updates (November 2026 Newsletter)LowNo effective date · Provider BulletinBrowse every Anthem BCBS change in the policy list