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Anthem BCBSMedicaid · Coverage · Provider Bulletin · VA · OB-GYN, Genetics, General Practice +1 moreMedium impact

[Virginia] Carelon Medical Benefits Management updates

Act
by Sep 28, 2026
Effective date
Sep 28, 2026
Identified
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.

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What to do

by Sep 28, 2026 · 5 steps
01Billing and clinical staff should review the updated Carelon guidelines for Genetic Testing for Inherited Conditions and Prenatal Screening using Cell-free DNA.
02Access the full guidelines at the Anthem provider portal (https://providernews.anthem.com/virginia/articles/carelon-medical-benefits-management-updates-31852).
03Ensure providers understand the updated clinical appropriateness criteria for these services when ordering or billing.
04No 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.
05Update office protocols and staff training materials as needed to reflect the new guidelines.

Original notice

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

See all Anthem BCBS changes →
[Virginia] Carelon Medical Benefits Management updatesMediumEffective Nov 15, 2026 · Provider Bulletin[Virginia] Carelon Medical Benefits Management updatesMediumEffective Aug 1, 2026 · Provider Bulletin[California] Carelon Medical Benefits Management, Inc. updatesMediumEffective Apr 23, 2026 · Provider Bulletin[Virginia] Carelon Medical Benefits Management, Inc. updatesMediumEffective Apr 23, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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