MedicaidPrior AuthMedium impact
[New York] Precertification/prior authorization requirement changes
Anthem BCBS·NY · Oncology·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
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.
Action Required
By March 31, 2026: Billing team must update prior authorization workflows in billing software to flag HCPCS code J3391 for Anthem New York Medicaid members. Update provider encounter forms and EMR templates to remind ordering providers that prior authorization is required before treatment. Staff 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. Do not process claims for J3391 without documented prior authorization approval. Non-compliant claims will be denied and may be deemed ineligible for payment, requiring appeal with medical records.