Medicare AdvantagePrior AuthMedium impact
[New York] Precertification/prior authorization requirement changes
Anthem BCBS·NY · Gastroenterology, Oncology, Neurosurgery +5 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Effective September 1, 2026, Anthem will require precertification/prior authorization for 25 new medical codes across multiple specialties including gastroenterology, oncology, neurosurgery, and fertility services for Medicare Advantage members in New York. Services performed without proper prior authorization may be denied payment.
Action Required
By September 1, 2026: Billing team must update prior authorization requirements in billing system for all 25 listed codes for Medicare Advantage members. Staff must obtain precertification through Availity Essentials or Provider Services before performing these services. Update encounter forms and EMR to flag these codes for prior auth requirements. Claims without proper authorization may be denied payment.