Medicare AdvantageAdministrativeLow impact
[Virginia] Improve respiratory outcomes through proactive care
Anthem BCBS·VA · Pulmonology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
We identified it
Sep 2, 2026
Summary
Anthem Blue Cross and Blue Shield (Virginia Medicare Advantage) is issuing a provider bulletin promoting proactive respiratory disease management for asthma and COPD patients. This is a care coordination and quality improvement initiative focused on identifying medication adherence gaps, controller therapy deficiencies, inhaler technique issues, and preventive care opportunities to reduce emergency department visits and hospitalizations. No billing code changes, prior authorization requirements, or coverage modifications are announced.
Action Required
No immediate billing workflow changes required. This is an informational bulletin encouraging clinical best practices. Billing and clinical teams should be aware that Anthem may conduct retrospective clinical case reviews on Medicare Advantage patients with frequent respiratory-related ED visits and hospitalizations to identify care gaps. Practices should ensure accurate coding and documentation of asthma (J45.x) and COPD (J43.x, J44.x) diagnoses, medication fills, preventive care services (vaccinations, smoking cessation counseling), and follow-up visits to support quality reporting metrics. No prior authorization, code changes, or documentation requirements are being mandated by this bulletin.