MedicaidCoverageMedium impact
[Virginia] Carelon Medical Benefits Management updates
Anthem BCBS·VA · Genetics, Oncology, Pain Management +1 more·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Jun 25, 2026
Summary
Carelon Medical Benefits Management is updating clinical appropriateness guidelines for HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid) effective August 1, 2026. Six guideline categories are being updated: Genetic Testing, Chromosomal Microarray Analysis, Genetic Liquid Biopsy in Cancer Management, Pharmacogenetic Testing, Whole Exome/Genome Sequencing, and Musculoskeletal Interventional Pain Management. Current prior authorization requirements remain unchanged; any new prior auth requirements will be communicated separately before implementation.
Action Required
By July 31, 2026: Billing and clinical staff should review updated Carelon guidelines at the provider portal (https://providernews.anthem.com/virginia/articles/carelon-medical-benefits-management-updates-effective-postin-30664) and download the current guideline documents for genetic testing, chromosomal microarray, liquid biopsy, pharmacogenetic testing, whole exome/genome sequencing, and musculoskeletal interventional pain management services. Distribute guidelines to all providers and clinical staff who order these services. Monitor for separate prior authorization requirement notices that may be distributed before August 1, 2026. No immediate billing workflow changes required unless separate prior auth notices are issued.