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[Virginia] National accounts: 2027 standard prior authorization requirements
Effective date
Jan 1, 2027
Identified
Oct 23, 2026
Summary
Anthem Blue Cross and Blue Shield's October 2026 notice lists the services that will require prior authorization for national accounts commercial members starting January 1, 2027. The list is broad, covering inpatient admissions (including OB stays beyond the federal minimum length of stay), genetic and diagnostic tests, durable medical equipment, transplant and cell and gene therapies, behavioral health programs, cosmetic and reconstructive surgery, and implanted devices, so scheduling and billing need updates before that date.
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What to do
Action · 11 steps
01Future transition effective 2027-01-01: Billing team: add the services in this notice to the prior auth tracker now, and set up a check so that each listed service is confirmed for Anthem national accounts members before it is scheduled.
02Inpatient admissions that need pre-certification are acute inpatient, acute rehabilitation, LTACH, skilled nursing facility, and OB delivery stays beyond the federal minimum length of stay (including newborn stays beyond the mother's stay).
03Emergency admissions do not need pre-certification, but the plan notification should be made as soon as possible.
04Behavioral health: acute inpatient, residential, in-home programs, transcranial magnetic stimulation, intensive outpatient and partial hospitalization are listed, and the notice says to check benefits for exclusions or specific pre-certification rules.
05Applied behavioral analysis pre-certification is recommended unless the group opts out, and retrospective review is allowed.
06Diagnostic testing: the notice lists genetic and hereditary cancer testing, whole genome and exome sequencing, gene panels, somatic tumor testing, prostate saturation biopsy and other tests.
07Front desk staff: check eligibility and the benefit for each service in Availity Essentials before scheduling.
08Gene replacement therapy requires clear confirmation that the group has excluded the benefit, or pre-certification if it is covered.
09Gender-affirming surgery and bariatric surgery require pre-certification if the benefit is covered.
10Transplant: inpatient admissions for all solid organ and bone marrow or stem cell transplants, and outpatient transplant-related procedures, are listed.
11Watch for the rest of the notice, since the source text is cut off partway through the list of other outpatient and surgical services.
Original notice
[Virginia] National accounts: 2027 standard prior authorization requirements
providernews.anthem.com · Always check the source before changing claims.