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[Virginia] September 2026 Provider Newsletter
Effective date
Not stated in the notice
Identified
Sep 2, 2026
Summary
This September 2026 Virginia provider newsletter from Anthem Blue Cross Blue Shield contains multiple policy updates across administrative, clinical, pharmacy, and prior authorization areas with staggered effective dates from October 2026 through January 2027. Key changes include new modifier 25 billing requirements for E&M services (effective November 1, 2026 for Medicaid), prior authorization requirements for specific procedures, clinical guideline updates, and new reimbursement policies for laboratory service modifiers 90 and 91 (effective December 1, 2026).
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What to do
Action · 8 steps
01REQUIREMENTS: Multiple effective dates require staged implementation.
02By October 1, 2026: Billing team must review Excludes1 notes for Commercial claims and update billing logic to prevent claim denials.
03By November 1, 2026: Billing team must implement modifier 25 requirement in billing software for Medicaid E&M services billed with XXX-status procedures; update encounter forms to alert providers when modifier 25 is required; failure to append modifier 25 will result in claim denials or payment reductions.
04By December 1, 2026: Billing team must begin obtaining prior authorization for procedure MED.00164 for Commercial plans; update precertification protocols in system; implement prior auth requirement for laboratory services using modifiers 90 and 91 for both Medicare Advantage and Medicaid effective December 1, 2026.
05By December 1, 2026: Review updated Carelon Medical Benefits Management Clinical Appropriateness Guidelines (effective November 15, 2026 for Medicare Advantage and Commercial; effective dates vary for Medicaid) and implement any billing or documentation changes.
06By January 1, 2027: Providers and billing staff must understand new Medicaid 2027 work requirements and assess patient eligibility impact on claims.
07Billing team should coordinate with provider and compliance staff.
08Consult the full policy details at https://providernews.anthem.com/virginia/publications/september-2026-provider-newsletter-5744 for specific guideline changes and clinical criteria updates.
Codes mentioned
259091
Original notice
[Virginia] September 2026 Provider Newsletter
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] September 2026 Provider NewsletterHighNo effective date · Newsletter[New York] September 2026 Provider NewsletterHighNo effective date · Newsletter[California] September 2026 Provider NewsletterHighNo effective date · Newsletter[Ohio] New combined reimbursement policy: Modifiers 90 and 91: Laboratory ServicesHighEffective Dec 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list