CommercialAdministrativeMedium impact
[Virginia] Reminder: Ensure billed charges and units are accurate on professional claims
Anthem BCBS·VA·Provider Bulletin
Effective date
Jul 17, 2026
We identified it
May 16, 2026
Summary
Effective July 17, 2026, Anthem will implement validation edits on professional claims to identify unusually high units or charge amounts that may indicate data entry errors. Claims with line-item charges or units exceeding established thresholds will be rejected prior to adjudication with specific error codes (A7:21, A7:583, A7:476). Billing teams must review rejected claims, correct errors, and resubmit.
Action Required
Before July 17, 2026: Billing team must implement internal validation procedures to review line-item charges (SV102) and units/quantity (SV103, SV104) on professional claims before submission to Anthem. Establish a process to flag claims with unusually high units or charges for manual review by providers or billing staff. When claims are rejected with error messages 'Charges or Units exceed the standard values for the billed services' or response codes A7:21, A7:583, A7:476 on 277CA transactions: (1) retrieve the claim detail from Availity, (2) verify that units and charges accurately reflect services provided, (3) correct any data entry errors in the billing system, and (4) resubmit the corrected claim. Ensure all billing staff understand these validation edits do not affect reimbursement rates or medical necessity determinations. Contact Anthem Provider Services or use Availity Chat with Payer during business hours for questions about specific claim rejections.