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Anthem BCBSCommercial · Prior Auth · Newsletter · VA · Allergy & Immunology, Pediatrics, PharmacyMedium impact

[Virginia] March 2026 Provider Newsletter

Effective date
Apr 1, 2026
Identified
May 3, 2026

Summary

This Virginia Anthem newsletter from March 2026 contains multiple policy updates across administrative, clinical, and pharmacy categories affecting Commercial, Medicare Advantage, and Medicaid plans. Key changes include: discontinuation of payment for two immunization administration fees (effective May 1, 2026 for Medicaid), updates to MCG Care Guidelines 30th edition (effective June 1, 2026), prior authorization requirement changes for specific codes effective April 1, 2026, and pharmacy/specialty updates effective April-June 2026.

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What to do

Action · 6 steps
01REQUIREMENTS: By April 1, 2026: Billing team must implement prior authorization requirements for CPT codes 64595, J3402, and J3403 for Medicaid claims.
02Update billing software to flag these codes for prior auth submission before claim submission.
03Verify current authorization status with Anthem Medicaid before processing.
04Additionally, by May 1, 2026: Billing team must discontinue billing for two immunization administration fees for Medicaid (specific codes not detailed in newsletter—contact Anthem for identification).
05Review MCG Care Guidelines 30th edition updates effective June 1, 2026 for Commercial and Medicare Advantage plans, and update clinical criteria in EMR and billing systems.
06Contact Anthem provider services at the Virginia provider relations line for the complete list of affected immunization codes and detailed guideline updates.
If missed: Failure to implement prior authorization requirements will result in claim denials.

Codes mentioned

64595J3402J3403

Original notice

[Virginia] March 2026 Provider Newsletter
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

See all Anthem BCBS changes →
[California] Prior authorization requirement changesMediumEffective May 1, 2026 · Provider Bulletin[New York] Prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[New York] March 2026 Provider NewsletterHighEffective Apr 1, 2026 · Newsletter[New York] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesVA policy changesAllergy & ImmunologyPediatricsPharmacyCode 64595Code J3402Code J3403

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