MedicaidPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement changes
Anthem BCBS·OH · Oncology·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Medicaid in Ohio will require precertification/prior authorization for CPT code J3391 (Injection, atidarsagene autotemcel, per treatment). Providers must obtain prior authorization before delivering this service or claims will be denied as ineligible for payment.
Action Required
Before April 1, 2026: Billing team must update billing software and encounter forms to require prior authorization for CPT J3391 for all Ohio Medicaid members. Configure system to flag claims for this code and route to prior auth submission process. Providers must contact Anthem via Availity Essentials (https://Availity.com), fax (877-643-0672), or phone (800-601-9935) to obtain precertification before service delivery. Train front desk and clinical staff to ensure prior authorization is obtained at scheduling. Failure to obtain prior authorization will result in claim denials and services being deemed ineligible for payment.