Medicare AdvantageAdministrativeHigh impact
[Virginia] Provider data attestation
Anthem BCBS·VA·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jul 1, 2026
Summary
Virginia providers contracted with Anthem must verify and update their demographic data every 90 days using the Provider Data Management (PDM) feature in Availity Essentials. Failure to comply will result in removal from the online provider directory and suppression from the FindCare tool effective January 1, 2026 for Commercial plans. Medicaid providers must update data through the DMAS Provider Services Solutions (PRSS) website instead.
Action Required
REQUIREMENTS:
By June 30, 2026 (and every 90 days thereafter): All providers and administrative staff must complete provider data attestation through Availity Essentials PDM to maintain directory listing and avoid suppression from FindCare tool. Specific actions:
1. Billing team and administrative staff: Log into https://Availity.com and navigate to My Providers > Provider Data Management.
2. Select "Verify Directory Listing" and review all demographic data (address, phone, specialties, hours, credentials) for accuracy.
3. Submit verified profile using either: (a) Directory Verification and Core PDM in the multipayer platform, or (b) Roster Upload feature for bulk updates.
4. Organizations with no changes may use Quick Verify button for one-click submission.
5. For Medicaid services only: Update provider data directly through DMAS PRSS website at https://virginia.hppcloud.com/ProviderEnrollment/EnrollmentCreate (do NOT use Availity for Medicaid).
6. For behavioral health providers assigned to Carelon: Follow Carelon attestation process. CAQH-registered providers: Attest through CAQH website.
7. Designate an Availity Essentials administrator to manage access if not already done; other staff can be granted PDM access by administrator.
CONSEQUENCES: Failure to attest within 90-day cycle will result in: (1) suppression from FindCare tool for Commercial business (effective January 1, 2026), (2) removal from online provider directory, (3) classification as noncompliant with health plan policies. Providers must attest to be unsuppressed.