CommercialPrior AuthMedium impact
[Virginia] Prior authorizations for genetic testing care services
Anthem BCBS·VA · Genetics, OB-GYN·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jul 21, 2026
Summary
Effective July 1, 2026, Anthem Blue Cross and Blue Shield in Virginia is consolidating all prior authorization reviews for genetic testing services (specifically pre-implantation embryo genetic testing) exclusively to Carelon Medical Benefits Management. Providers must submit all genetic testing prior authorization requests to Carelon instead of Anthem, streamlining the review process through a single entity.
Action Required
By July 1, 2026: Billing and clinical staff must redirect all genetic testing prior authorization submissions to Carelon Medical Benefits Management instead of Anthem. Update billing system workflows, encounter templates, and provider communication protocols to reflect the new submission pathway. Contact Carelon Medical Benefits Management Provider Services via https://www.providerportal.com for submission procedures and portal access. Failure to submit to the correct entity may result in delayed approvals or claim denials. This change applies only to groups that have enrolled in the Carelon Medical Benefits Management genetic testing program.