ExchangeAdministrativeMedium impact
[Virginia] EMR alerts aim to close gaps in care for Affordable Care Act members
Anthem BCBS·VA·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 3, 2026
Summary
Anthem Blue Cross and Blue Shield will now send EMR alerts to flag care gaps for ACA plan members, prompting providers to schedule follow-up visits and ensure comprehensive clinical documentation. Billing teams must ensure claims are submitted with highest specificity of coding and all relevant clinical data to support risk adjustment reporting requirements.
Action Required
By May 1, 2026: Providers and billing teams must review incoming EMR alerts from Anthem for ACA members with identified care gaps. Ensure clinical staff addresses gaps through timely scheduling and comprehensive assessments. Billing team must verify all claims for flagged patients include highest specificity coding and complete clinical documentation supporting the documented conditions. Update claim submission procedures to capture all relevant clinical data. Contact prospectiveteam@anthem.com with questions regarding alert accuracy or clinical interpretation.