CommercialAdministrativeMedium impact
[Virginia] Continued collaboration on DRG clinical and coding validation
Anthem BCBS·VA·Coding
Effective date
Jul 23, 2026
We identified it
Jul 28, 2026
Summary
Anthem Blue Cross and Blue Shield will continue conducting DRG clinical and coding validation audits in Virginia through its Complex and Clinical Audit (CCA) team and designated external vendors (EXL and Ceris). Healthcare providers should expect ongoing medical record requests and audit correspondence from Anthem and/or its vendor partners, with efforts to minimize duplicate requests.
Action Required
Effective immediately (as of July 23, 2026): Billing and medical records teams must be prepared to receive DRG validation audit requests from Anthem's CCA team and external vendors EXL and Ceris. Establish a process to track and respond to medical record requests from all three entities (Anthem internal team + two external vendors) to avoid submission delays. Designate a point of contact for audit correspondence and ensure timely medical record retrieval and submission. Document all requests received to identify and report duplicate requests to your Anthem provider relationship management representative. No system updates required, but workflow adjustments are needed to manage multiple audit request sources efficiently.