CommercialPrior AuthMedium impact
[Virginia] Virginia prior authorizations listing update
Anthem BCBS·VA·Provider Bulletin
Effective date
Jun 1, 2026
We identified it
Jun 1, 2026
Summary
Anthem Blue Cross Blue Shield Virginia has updated its prior authorization requirements effective June 1, 2026. Billing teams must access the updated precertification/prior authorization listings from Anthem's provider portal, with separate requirements documents for HMO/EPO plans versus other commercial plan types (PPO-style). The specific procedures requiring prior auth have changed and must be referenced from the updated documentation.
Action Required
By June 1, 2026: Billing team must access Anthem's Virginia provider portal (https://anthem.com > For Providers > Virginia > Commercial provider site > Resources > Prior Authorization) and download the updated precertification/prior authorization requirements documents. Determine which document applies based on member plan type: 'Virginia HMO/EPO Standard precertification/prior authorization requirements' for HMO/EPO plans, or 'Virginia standard precertification/prior authorization requirements' for PPO-style and other commercial plans. Cross-reference all Virginia Anthem commercial claims against the updated procedure codes and descriptions in these documents. Update internal billing workflows, templates, and system edits to reflect new prior auth requirements. Staff should verify which document version applies for each claim before submission. Failure to obtain required prior authorizations will result in claim denials.