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Anthem BCBSMedicaid · Prior Auth · Provider Bulletin · NY · OncologyMedium impact

[New York] Precertification/prior authorization requirement changes

Act
by Mar 31, 2026
Effective date
Apr 1, 2026
Identified
May 7, 2026

Summary

Effective April 1, 2026, Anthem Medicaid in New York will require precertification/prior authorization for HCPCS code J3391 (atidarsagene autotemcel injection). Providers must obtain prior auth before administering this service or claims will be denied as ineligible for payment.

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What to do

by Mar 31, 2026 · 5 steps
01Billing team must update prior authorization workflows in billing software to flag HCPCS code J3391 for Anthem New York Medicaid members.
02Update provider encounter forms and EMR templates to remind ordering providers that prior authorization is required before treatment.
03Staff must obtain prior auth using one of the following methods: Availity Essentials (https://Availity.com), fax to 800-964-3627, or phone 800-450-8753.
04Do not process claims for J3391 without documented prior authorization approval.
05Non-compliant claims will be denied and may be deemed ineligible for payment, requiring appeal with medical records.

Codes mentioned

J3391

Original notice

[New York] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[California] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Virginia] Prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesNY policy changesOncologyCode J3391

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