CommercialPrior AuthHigh impact
[Virginia] Authorization required for sick newborn DRG payment
Anthem BCBS·VA · Pediatrics, OB-GYN·Coding
We identified it
Jun 1, 2026
Summary
Anthem Virginia now requires prior authorization for sick newborn DRG payments. This affects hospitals and birthing centers that bill for complex newborn care under DRG reimbursement methodology.
Action Required
Immediately: Billing team must implement prior authorization workflow for all sick newborn DRG claims submitted to Anthem Virginia. Contact Anthem to obtain authorization before admitting sick newborns or within required timeframe. Update billing system to flag sick newborn DRGs for prior auth verification. Claims submitted without proper authorization will be denied.