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Anthem BCBSMedicare Advantage · Administrative · Provider Bulletin · VA · Cardiology, Cardiothoracic Surgery, GastroenterologyMedium impact

[Virginia] Carelon Medical Benefits Management updates

Act
by Nov 15, 2026
Effective date
Nov 15, 2026
Identified
Aug 29, 2026

Summary

Anthem Blue Cross and Blue Shield in Virginia is adopting Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective November 15, 2026, for two procedures: Cardiovascular Catheter-Based Closure of Patent Foramen Ovale and Surgical Upper Gastrointestinal Endoscopy. Existing prior authorization requirements remain unchanged, but providers should monitor for future prior authorization updates that will be communicated separately.

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What to do

by Nov 15, 2026 · 6 steps
01Billing and clinical teams must review and download the updated Carelon Medical Benefits Management guidelines for.
02Cardiovascular Catheter-Based Closure of Patent Foramen Ovale.
03Surgical Upper Gastrointestinal Endoscopy from the Anthem provider portal.
04Ensure providers and billing staff are familiar with the new clinical appropriateness criteria.
05No immediate billing system changes are required at this time, as existing prior authorization requirements have not changed.
06Monitor for future separate communications regarding any new prior authorization requirements that may be implemented for these services.

Original notice

[Virginia] Carelon Medical Benefits Management updates
providernews.anthem.com · Always check the source before changing claims.
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Related changes

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[New York] Carelon Medical Benefits Management updatesMediumEffective Nov 15, 2026 · Provider Bulletin[Virginia] Carelon Medical Benefits Management updatesMediumEffective Sep 28, 2026 · Provider Bulletin[Georgia] Carelon Medical Benefits Management updatesMediumEffective Nov 15, 2026 · Provider Bulletin[California] Carelon Medical Benefits Management updatesMediumEffective Sep 28, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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Anthem BCBS policiesVA policy changesCardiologyCardiothoracic SurgeryGastroenterology

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