CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)
Anthem BCBS·VA · Cardiology, General Practice·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 29, 2026
Summary
Carelon Medical Benefits Management has updated prior authorization and precertification requirements for Virginia commercial plans, effective December 1, 2026. Changes span Additional Outpatient and Cardiovascular service categories. The billing team must identify which specific procedures now require prior authorization under these updated guidelines.
Action Required
Before December 1, 2026: Billing team must obtain the detailed policy documents for Additional Outpatient (updated August 6, 2026) and Cardiovascular (updated August 12, 2026) service categories from Carelon/Anthem Virginia. Review which specific CPT/HCPCS codes now require prior authorization. Update billing system workflows and encounter form templates to enforce prior authorization requirements for affected codes in these two categories. Train front desk and clinical staff on new prior auth triggers. Failure to obtain required prior authorizations will result in claim denials for Virginia commercial plan members.