CommercialPrior AuthMedium impact
[Virginia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines
Anthem BCBS·VA·Provider Bulletin
We identified it
May 28, 2026
Summary
Carelon Medical Benefits Management has updated their Clinical Appropriateness Guidelines for Virginia providers. This affects prior authorization and coverage determination processes for services managed by Carelon under Anthem plans.
Action Required
Immediately: Billing team should access the updated Carelon Medical Benefits Management Clinical Appropriateness Guidelines via the Anthem provider portal. Review changes to prior authorization requirements and coverage criteria for services managed by Carelon. Update internal processes and staff training based on new guidelines to ensure compliance with coverage determinations.