MedicaidAdministrativeHigh impact
[Virginia] Update on long‑term services and supports (LTSS) authorization and care coordination processes
Anthem BCBS·VA · Geriatrics, Palliative Care·Provider Bulletin
Effective date
Feb 1, 2026
We identified it
May 3, 2026
Summary
Virginia Medicaid is implementing a new LTSS (Long-Term Services and Supports) authorization and care coordination process that aligns authorization timelines with LOCERI due dates, effective on staggered regional dates from February through August 2026. Authorization endpoints will now occur 30 days after LOCERI due dates, and providers must collaborate with care managers and participate in Interdisciplinary Care Team meetings before submitting authorization requests. This requires workflow changes to the authorization submission process and mandatory staff training attendance.
Action Required
REQUIREMENTS: By January 1, 2026 (or one month prior to your region's go-live date): (1) Billing/authorization staff must attend mandatory training webinars hosted by Anthem HealthKeepers to understand the new aligned authorization process, submission workflow (Provider > Care Manager/ICT > UM > Final Authorization), and authorization endpoint rules. (2) Update internal authorization submission procedures and workflow documentation to reflect the new standardized submission flow and the requirement that authorizations end 30 days after LOCERI due dates. (3) Establish protocols for collaborating with care managers prior to authorization submissions and ensure staff understand they must participate in Interdisciplinary Care Team (ICT) meetings before submitting requests. (4) Implement monthly member eligibility verification procedures into billing workflows to maintain up-to-date coordination. (5) Educate clinical and billing staff on the new process and communicate changes to members regarding their role in coordinated care. (6) Update authorization request forms and checklists to ensure Health Risk Assessments (HRAs) are completed before submission. Consequences: Failure to comply with the new submission workflow and authorization alignment requirements will result in claim resubmissions, denials, and service delivery gaps for Medicaid LTSS members. Regional rollout dates: Tidewater (Feb 1, 2026), Region 2 (Apr 1, 2026), Northern/Winchester/Charlottesville (Jun 1, 2026), Roanoke/Alleghany/Southwest (Aug 1, 2026). Contact valtsspr@anthem.com for questions.