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[New York] Medical Policies and Clinical Utilization Management Guidelines update
Act
by Nov 30, 2026
Effective date
Nov 30, 2026
Identified
Oct 29, 2026
Summary
Anthem Blue Cross Blue Shield in New York is updating 26 medical policies and clinical utilization management guidelines, effective November 30, 2026. These updates include new policies on gene therapies, cellular immunotherapy, and device treatments, as well as revisions to existing guidelines for procedures including breast surgery, deep brain stimulation, cardiac rehabilitation, and cochlear implants. Some policy changes may result in services previously covered being found not medically necessary, requiring prior authorization review updates.
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What to do
by Nov 30, 2026 · 6 steps
01Billing and clinical teams must review all 26 updated medical policies and clinical UM guidelines listed in this notice on the Anthem Medical Policies and Clinical UM Guidelines website.
02Identify which guidelines affect your practice's common procedures (particularly breast procedures, deep brain stimulation, cardiac/pulmonary rehabilitation, cochlear implants, sinus surgery, and cystourethroscopy).
03Update prior authorization workflows, credentialing requirements, and billing system rules to reflect new coverage criteria and medical necessity indications.
04Train front desk, clinical, and billing staff on new policy positions that may result in previously covered services now being found not medically necessary.
05Document the effective date (November 30, 2026) for compliance audits.
06Obtain specific billing code mappings from Anthem's policy documentation to ensure claims are submitted with appropriate authorization.
Original notice
[New York] 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 →[New York] Medical Policy and Clinical Guideline updatesHighEffective Feb 1, 2027 · Medical Policy[New York] Clinical Criteria updates (November 2026 Newsletter)MediumNo effective date · Provider Bulletin[California] Medical Policies and Clinical Utilization Management Guidelines updateMediumEffective Jan 30, 2027 · Prior Authorization[New York] Clinical Criteria updatesHighEffective Nov 29, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list