MedicaidCoverageMedium impact
[Virginia] Carelon Medical Benefits Management updates
Anthem BCBS·VA · OB-GYN, Genetics, General Practice +1 more·Provider Bulletin
Effective date
Sep 28, 2026
We identified it
Aug 29, 2026
Summary
Carelon Medical Benefits Management has updated clinical appropriateness guidelines for HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid) effective September 28, 2026. Two guideline updates are being adopted: Genetic Testing for Inherited Conditions and Prenatal Screening using Cell-free DNA. No new prior authorization requirements are being implemented at this time, but providers should monitor for future notices if prior auth is added.
Action Required
By September 28, 2026: Billing and clinical staff should review the updated Carelon guidelines for Genetic Testing for Inherited Conditions and Prenatal Screening using Cell-free DNA. Access the full guidelines at the Anthem provider portal (https://providernews.anthem.com/virginia/articles/carelon-medical-benefits-management-updates-31852). Ensure providers understand the updated clinical appropriateness criteria for these services when ordering or billing. No immediate billing workflow changes are required, but remain alert for a separate notice if prior authorization requirements are added to these services in the future. Update office protocols and staff training materials as needed to reflect the new guidelines.