Medicare AdvantageAdministrativeMedium impact
[Virginia] Clinical Criteria updates (July 2026 Newsletter)
Anthem BCBS·VA·Provider Bulletin
Effective date
Jul 23, 2026
We identified it
Jul 1, 2026
Summary
Anthem Virginia has issued clinical criteria updates effective on multiple dates in July and August 2026 for both Medicare Advantage and Medicaid plans. The bulletin announces guideline updates but does not provide specific clinical criteria details, billing codes, or policy changes in the provided excerpt.
Action Required
By July 23, 2026: Billing team and clinical staff must access the full clinical criteria documents linked in the Anthem provider bulletin to identify specific changes. Visit https://providernews.anthem.com/virginia/articles/clinical-criteria-updates-july-2026-newsletter-30936 or scan the provided QR code to download complete policy details. Review changes for Medicare Advantage (effective July 23, 2026) and Medicaid (effective August 1, 2026) plans separately. Update billing software, prior authorization workflows, and provider documentation templates accordingly once specific criteria are reviewed. Failure to align with updated criteria may result in claim denials or requests for additional documentation.