Medicare AdvantagePrior AuthHigh impact
[Virginia] Prior authorization requirement changes
Anthem BCBS·VA · Gastroenterology, Urology, Neurosurgery +5 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Effective September 1, 2026, Anthem will require prior authorization for 28 additional medical codes for Medicare Advantage members in Virginia, including gastroenterology tests, neurostimulation procedures, and fertility treatments. Services performed without obtaining required precertification may be denied for payment.
Action Required
By September 1, 2026: Billing team must update prior authorization systems to require precertification for all 28 listed codes for Anthem Medicare Advantage members in Virginia. Update encounter forms and EMR templates to alert providers about new prior auth requirements. Train staff on using Availity Essentials for precertification requests. Failure to obtain prior authorization will result in claim denials and potential appeals processes.