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Anthem BCBSMedicare Advantage · Administrative · Provider Bulletin · VAMedium impact

[Virginia] Clinical Criteria updates (September 2026 Newsletter)

Act
by Sep 28, 2026
Effective date
Not stated in the notice
Identified
Aug 29, 2026

Summary

This is a Virginia-specific clinical criteria update newsletter from Anthem covering multiple effective dates (September 28, 2026, and October 1, 2026) for Medicare Advantage and Medicaid plans. However, the source document does not contain the actual clinical criteria changes—only links and references to where details can be found. The billing team cannot implement specific changes without accessing the full policy content.

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What to do

by Sep 28, 2026 · 3 steps
01Billing team must access the full clinical criteria updates through the Anthem provider portal (https://providernews.anthem.com/virginia/) or contact Anthem directly to obtain specific details on which CPT codes, HCPCS codes, or services are affected.
02The newsletter references updates effective September 28, 2026 (Medicare Advantage) and October 1, 2026 (Medicare Advantage and Medicaid), but does not specify which codes or procedures changed.
03Once details are obtained, update billing software, encounter templates, and prior authorization rules accordingly.
If missed: Failure to implement required changes by the effective dates may result in claim denials or improper reimbursement.

Original notice

[Virginia] Clinical Criteria updates (September 2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

See all Anthem BCBS changes →
[Virginia] Clinical Criteria updatesHighEffective Sep 28, 2026 · Provider Bulletin[Virginia] Clinical Criteria updatesHighEffective Oct 1, 2026 · Provider Bulletin[Virginia] Clinical Criteria updates (July 2026 Newsletter)MediumEffective Jul 23, 2026 · Provider Bulletin[Virginia] Clinical Criteria updatesHighEffective Aug 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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