CommercialAdministrativeMedium impact
[Virginia] Carelon Medical Benefits Management to manage PA reconsiderations; submit within 10 business days
Anthem BCBS·VA·Provider Bulletin
Effective date
Jul 11, 2026
We identified it
May 30, 2026
Summary
Effective July 11, 2026, Carelon Medical Benefits Management will now handle reconsiderations of their own initial prior authorization determinations for Virginia commercial plans. Providers must submit reconsideration requests within 10 business days of the initial determination via the Carelon provider portal or by phone at 866-789-0158.
Action Required
By July 11, 2026: Billing and prior authorization staff must update internal workflows to direct all PA reconsideration requests to Carelon Medical Benefits Management instead of any previous appeal channels. Train staff to submit reconsiderations within 10 business days of initial denial using the Carelon provider portal (www.providerportal.com) or contact center (866-789-0158). Document the new process in billing procedures. Failure to meet the 10-business-day deadline will result in loss of reconsideration rights.