MedicaidCoverageMedium impact
[Virginia] Carelon Medical Benefits Management, Inc. updates
Anthem BCBS·VA · Genetics, Oncology, Internal Medicine +1 more·Provider Bulletin
Effective date
Apr 23, 2026
We identified it
May 18, 2026
Summary
Carelon Medical Benefits Management has updated clinical appropriateness guidelines for HealthKeepers, Inc. (Virginia Medicaid) effective April 23, 2026. Updates include new guidelines for Genetic Testing and Hereditary Cancer Testing. No new prior authorization requirements are being implemented at this time, though providers should monitor for future notices if prior auth is added.
Action Required
By April 23, 2026: Billing and clinical staff should review the updated Carelon Medical Benefits Management guidelines for Genetic Testing and Hereditary Cancer Testing (published April 4, 2026) to ensure compliance with new clinical appropriateness standards. Access guidelines via the Carelon website or provider news portal. No immediate billing system changes are required at this time, but monitor for separate notice if prior authorization requirements are implemented. Distribute updated guidelines to all providers and office staff involved in ordering or billing genetic testing services for HealthKeepers, Inc. Medicaid members.