Anthem BCBSMedium ImpactPrior Auth
[Virginia] Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines
Published May 18, 2026
AI Summary
Carelon Medical Benefits Management, Inc. has updated their Clinical Appropriateness Guidelines for Virginia providers. This affects prior authorization and coverage determination processes for services managed by Carelon.
Action Required
Immediately: Billing team should review the updated Carelon Medical Benefits Management Clinical Appropriateness Guidelines at the provided URL to identify specific changes to prior authorization requirements, coverage criteria, and documentation standards. Update internal workflows and staff training accordingly to ensure compliance with new guidelines.
Plan Types
Commercial
States
VA
Specialties
all-specialties