CommercialPrior AuthMedium impact
[Virginia] March 2026 Provider Newsletter
Anthem BCBS·VA · Allergy & Immunology, Pediatrics, Pharmacy·Newsletter
Effective date
Apr 1, 2026
We identified it
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.
Action Required
REQUIREMENTS: By April 1, 2026: Billing team must implement prior authorization requirements for CPT codes 64595, J3402, and J3403 for Medicaid claims. Update billing software to flag these codes for prior auth submission before claim submission. Verify current authorization status with Anthem Medicaid before processing. Additionally, 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). Review 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. Contact Anthem provider services at the Virginia provider relations line for the complete list of affected immunization codes and detailed guideline updates. Failure to implement prior authorization requirements will result in claim denials.