MedicaidPrior AuthHigh impact
[Virginia] Prior authorization requirement changes
Anthem BCBS·VA · Wound Care, Oncology, Orthopedics +4 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 29, 2026
Summary
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid) is adding prior authorization requirements for 86 specific billing codes across wound care products, prosthetics, neurostimulator devices, and oncology testing. All services using these codes must obtain precertification before delivery to Medicaid members, or claims will be denied.
Action Required
By December 15, 2026: Billing team must update billing system to require prior authorization for all 86 affected codes (listed above) for HealthKeepers, Inc./Anthem HealthKeepers Plus Medicaid members in Virginia. Configure system to block claims submission without documented prior authorization approval. Update all encounter forms, templates, and provider rooming checklists to alert clinical and billing staff that these codes require precertification before service delivery. Coordinate with providers and wound care suppliers to establish prior authorization submission workflow through Availity Essentials or Provider Services. Train billing staff on new requirements. Failure to obtain prior authorization will result in claim denials and patient balance responsibility.