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[New York] Precertification/prior authorization requirement changes
Effective date
Mar 1, 2027
Identified
Nov 3, 2026
Summary
Effective March 1, 2027, Anthem is adding prior authorization requirements for five specific procedure codes (95921, 95922, 95923, 95924, C9777, E0767, J3386) for Medicare Advantage members and certain dual-eligible plans in New York. The practice must obtain prior authorization before scheduling or billing these services, or claims will be denied.
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What to do
Action · 5 steps
01Before March 1, 2027.
02Billing team: Update charge entry and claim edit logic to flag these codes (95921, 95922, 95923, 95924, C9777, E0767, J3386) for Anthem Medicare Advantage and FIDE dual-eligible members in New York, ensuring prior authorization is obtained before claims are submitted.
03Tell providers and front desk staff to request prior authorization through Anthem before scheduling any patient for these services; provide them with Anthem's authorization contact number (800-450-8753) and note that detailed precertification requirements are available at https://anthembluecross.com/ny/provider or https://Availity.com for contracted providers.
04Watch for Anthem's detailed precertification requirements (not fully listed in this notice) by checking Availity Essentials or contacting Provider Services.
05Claims submitted without prior authorization will be denied; appeals with additional medical records may be submitted online through Availity Essentials or by phone.
Codes mentioned
95921959229592395924C9777E0767J3386
Original notice
[New York] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
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