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Anthem BCBSCommercial · Prior Auth · Provider Bulletin · VA · Cardiology, General PracticeMedium impact

[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)

Effective date
Dec 1, 2026
Identified
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.

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What to do

Action · 4 steps
01Before 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.
02Review which specific CPT/HCPCS codes now require prior authorization.
03Update billing system workflows and encounter form templates to enforce prior authorization requirements for affected codes in these two categories.
04Train front desk and clinical staff on new prior auth triggers.
If missed: Failure to obtain required prior authorizations will result in claim denials for Virginia commercial plan members.

Original notice

[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
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Related changes

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[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (October 2026 Newsletter)HighEffective Jan 1, 2027 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)MediumEffective Dec 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)MediumEffective Dec 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)HighEffective Dec 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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