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[Virginia] Medical Policies and Clinical Utilization Management Guidelines update
Act
by Jun 19, 2026
Effective date
Jun 19, 2026
Identified
Jun 13, 2026
Summary
Virginia HealthKeepers (BCBS) has updated multiple medical policies and clinical utilization management guidelines effective June 19, 2026, affecting Medicaid members. Changes include revisions to coverage criteria for various services including gene therapy, surgical treatments, medical devices, and new guidelines for assisted reproductive technology and sleep testing that may impact prior authorization requirements.
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What to do
by Jun 19, 2026 · 3 steps
01Review all updated medical policies and clinical UM guidelines on the HealthKeepers Medical Policies & Clinical UM Guidelines website.
02Billing team must verify current prior authorization requirements for affected services including cosmetic/reconstructive skin procedures, electrical stimulation devices, gene therapies, sleep apnea surgeries, wheelchairs and mobility devices, hearing aids, sleep testing, bariatric surgery, and assisted reproductive technology.
03Update prior authorization workflows as some previously covered services may now require additional documentation or may be deemed not medically necessary.
Original notice
[Virginia] Medical Policies and Clinical Utilization Management Guidelines update
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Virginia] Medical Policies and Clinical Utilization Management Guidelines updateMediumEffective Nov 30, 2026 · Prior Authorization[Virginia] Medical Policies and Clinical Utilization Management Guidelines updateHighEffective Nov 1, 2026 · Prior Authorization[Virginia] Medical Policies and Clinical Utilization Management Guidelines updateHighEffective Oct 18, 2026 · Prior Authorization[Virginia] Medical Policies and Clinical Utilization Management Guidelines updateHighEffective Sep 28, 2026 · Prior AuthorizationBrowse every Anthem BCBS change in the policy list