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[Virginia] National accounts: 2027 standard prior authorization requirements
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026
Summary
Anthem Blue Cross and Blue Shield (Virginia) is expanding its prior authorization (PA) requirements effective January 1, 2027, for national accounts. The policy now mandates pre-certification for numerous advanced procedures, diagnostic tests, durable medical equipment, gene therapies, CAR T-cell treatments, transplants, mental health services, and surgical procedures. This represents a comprehensive broadening of PA scope across multiple service categories.
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What to do
by Dec 31, 2026 · 12 steps
01Billing team must update all billing software and encounter templates to reflect new prior authorization requirements for Anthem Blue Cross and Blue Shield commercial plans in Virginia.
02Configure system to require PA submission for all inpatient admissions (acute, rehabilitation, LTACH, SNF, OB deliveries beyond federal mandate).
03Enable PA requirements for advanced diagnostic testing (chromosomal microarray, genetic testing, hereditary cancer testing, liquid biopsy, PFAS testing, prostate saturation biopsy, somatic tumor testing, Alzheimer's biomarkers, genomic sequencing, and wireless capsule endoscopy).
04Activate PA requirements for specified DME/prosthetics (AAC devices, brain-computer interfaces, compression devices, TTF devices, FES/TES, chest compression devices, robotic rehabilitation systems, infusion pumps, percussive ventilation devices, prosthetic devices, bone stimulation devices, robotic exoskeletons, and powered mobility devices).
05Require pre-certification for gender-affirming surgery (if covered).
06Mandate PA for all solid organ transplants and bone marrow/stem cell transplants (inpatient and outpatient).
07Implement PA for all CAR T-cell therapies and gene replacement therapies listed.
08Configure PA requirements for mental health/substance abuse services (acute inpatient, TMS, residential care, in-home programs, ABA, IOP, PHP).
09Enable PA for extensive outpatient surgical services including bariatric surgery, cardiac devices, cochlear implants, and numerous other procedures.
10Providers and billing staff must be trained on new requirements before January 1, 2027.
11Failure to obtain required prior authorization will result in claim denials and payment delays.
12Front desk staff must screen all scheduled procedures against updated PA requirements at time of scheduling.
Original notice
[Virginia] National accounts: 2027 standard prior authorization requirements
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Virginia] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider Bulletin[California] National accounts: 2027 prior authorization requirementsMediumEffective Jan 1, 2027 · Provider Bulletin[Ohio] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider Bulletin[Georgia] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list
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