MedicaidAdministrativeMedium impact
[Virginia] Continued collaboration on DRG clinical and coding validation
Anthem BCBS·VA·Coding
Effective date
Jul 22, 2026
We identified it
Jul 23, 2026
Summary
HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid) will continue conducting DRG clinical and coding validation audits through its internal Complex and Clinical Audit team and designated external vendors (EXL and Ceris). Providers should expect to receive medical record requests from HealthKeepers and/or vendor partners as part of ongoing DRG validation activities, with efforts made to minimize duplicate requests.
Action Required
Immediately: Billing and medical records teams should acknowledge this policy and ensure processes are in place to promptly respond to medical record requests from HealthKeepers, Inc. and its designated vendor partners (EXL and Ceris). Establish a tracking system to document all DRG validation audit requests received to identify and prevent duplicate medical record submissions. Designate a point of contact for coordination with HealthKeepers' provider relationship management representative. No system changes required, but staff should be trained to recognize and prioritize DRG audit correspondence. Delayed or missing medical records may result in claim denials or payment adjustments.