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[Virginia] Review Excludes1 Notes to help keep claims on track
Anthem BCBS·VA·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
Effective October 1, 2026, Anthem Blue Cross and Blue Shield (Virginia) will implement enhanced Excludes1 claim editing to enforce ICD-10-CM coding standards. Billing teams must review Excludes1 Notes before submitting claims to ensure diagnosis code combinations comply with coding guidelines. Claims with unsupported diagnosis code combinations will be subject to edit denial, requiring correction or dispute submission.
Action Required
By September 30, 2026: Billing team must implement a pre-submission claim review process to verify all diagnosis code combinations comply with ICD-10-CM Excludes1 Notes before submission. (1) Train all billing and coding staff on ICD-10-CM Excludes1 guidelines, emphasizing that category-level notes apply to all codes within that category and code-specific notes apply only to individual codes. (2) Update billing software or implement manual review checkpoints to flag diagnosis code combinations that violate Excludes1 requirements. (3) Establish a protocol: when an Excludes1 edit is received, first verify coding accuracy against ICD-10-CM guidelines; if the combination is correct per guidelines, submit a dispute via Availity.com with supporting documentation; if coding is incorrect, submit a corrected claim. (4) Document the process and communicate to all providers submitting claims to Anthem Virginia. Failure to address Excludes1 edits will result in claim denials and processing delays.