Medicare AdvantageReimbursementHigh impact
[Virginia] Reimbursement policy update: Preventive Medicine and Sick Visits on the Same Day
Anthem BCBS·VA·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem will reduce reimbursement to 50% of the applicable fee schedule when sick visits occur on the same day as preventive/wellness visits, or when preventive services are billed on the same day as wellness visits. This applies to Medicare Advantage plans in Virginia and requires billing teams to implement bundling/reduction logic for same-day visit scenarios.
Action Required
By March 31, 2026: Billing team must update claims processing system to automatically reduce reimbursement to 50% for sick visits or preventive services when billed on the same date of service as wellness/preventive visits for Anthem Medicare Advantage plans in Virginia. Update billing software edits and fee schedules to reflect the 50% reduction rule. Providers should be notified of this bundling requirement via team communication and encounter documentation reminders. Verify system changes during testing phase to prevent underbilling. Claims submitted on or after April 1, 2026 without proper 50% reduction may be subject to audit or recoupment by Anthem.