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 has updated their clinical appropriateness guidelines for Virginia providers. This affects prior authorization requirements and medical necessity criteria for various services, though specific details require reviewing the full policy document.
Action Required
Immediately: Access the full policy document at the provided URL to review updated clinical guidelines. Billing and clinical staff should identify which services require updated prior authorization processes or documentation requirements. Update internal protocols based on the new Carelon guidelines to ensure compliance and avoid claim denials.
Plan Types
Commercial
States
VA
Specialties
all-specialties