[Virginia] June 2026 Provider Newsletter

REQUIREMENTS: - By June 1, 2026: Billing team must review and implement the Virginia prior authorizations listing update for Commercial plans. Update billing system rules and encounter forms accordingly. - By July 1, 2026: For Medicare Advantage plans, update precertification/prior authorization requirements for parenteral nutrition codes. Verify all parenteral nutrition claims require updated authorization process. - By July 1, 2026: For Medicaid plans, update prior authorization and step therapy requirements for medications billed under medical benefit. Configure billing system to reflect new authorization rules before submission. - By July 17, 2026: All billing team members must ensure billed charges and units are accurate on professional claims across all plan types (Commercial, Medicare Advantage, Medicaid). Implement quality checks in billing workflow to prevent claim denials. - By September 1, 2026: For Medicaid and Medicare Advantage plans, implement all prior authorization requirement changes. Update system rules and provider communication materials. - Immediately: Obtain the specific affected codes and clinical criteria from Anthem's provider portal (Availity) or contact Anthem directly, as this newsletter does not list specific CPT/HCPCS codes. Billing team must not submit claims until specific code requirements are confirmed. - By June 19, 2026: For Medicaid plans, review updated Medical Policies and Clinical Utilization Management Guidelines. FAILURE TO IMPLEMENT: Claims will be denied for missing or incorrect prior authorizations, impacting cash flow and requiring rework.