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Anthem BCBSCommercial · Prior Auth · Newsletter · NYHigh impact

[New York] March 2026 Provider Newsletter

Effective date
Apr 1, 2026
Identified
May 3, 2026

Summary

This is a March 2026 provider newsletter from Anthem summarizing multiple administrative, educational, and policy updates across New York commercial, Medicare Advantage, and Medicaid plans. Key billing-related changes include: (1) Prior authorization requirement changes effective April 1, 2026 for Medicaid and June 1, 2026 for Commercial (codes 64595, J3402, J3403); (2) Modifier 26 (professional services) billing changes on UB-04 for outpatient facilities effective April 1, 2026; (3) Bundled services/supplies reimbursement policy updates effective June 1, 2026; (4) MCG Care Guidelines 30th edition updates effective June 1, 2026; and (5) New MLTC fax numbers and dispute submission process changes effective March 1, 2026.

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What to do

Action · 13 steps
01REQUIREMENTS: Before April 1, 2026: Billing team must update systems to implement prior authorization requirement changes for CPT 64595 and HCPCS codes J3402 and J3403 on Commercial plans.
02Audit current claims for these codes and implement new prior auth workflows.
03Update provider encounter forms and internal billing guidelines.
04Before April 1, 2026: Billing team must update UB-04 claim submission procedures for outpatient facility claims to properly apply modifier 26 (professional services).
05Review current facility billing templates and train billing staff on modifier usage.
06Failure to apply correct modifiers may result in claim denials or improper reimbursement.
07Before June 1, 2026: Billing team must review and implement new MCG Care Guidelines 30th edition updates for all plan types (Commercial, Medicare Advantage, Medicaid).
08Update clinical documentation requirements and prior authorization criteria in billing system.
09Before June 1, 2026: Billing team must update reimbursement procedures for bundled services and supplies on facility claims per new Commercial plan policy.
10Review affected service bundles and modify fee schedules accordingly.
11Before March 1, 2026: Medicaid billing team must update MLTC dispute submission process to use Availity Essentials portal instead of fax.
12Update staff training and adjust new fax numbers for any remaining MLTC communications.
13Implement new submission procedures immediately to avoid processing delays.

Codes mentioned

64595J3402J3403

Original notice

[New York] March 2026 Provider Newsletter
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

See all Anthem BCBS changes →
[California] Prior authorization requirement changesMediumEffective May 1, 2026 · Provider Bulletin[New York] Prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Virginia] March 2026 Provider NewsletterMediumEffective Apr 1, 2026 · Newsletter[New York] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesNY policy changesCode 64595Code J3402Code J3403

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