Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Nephrology, Oncology·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem Blue Cross and Blue Shield Virginia is adding prior authorization requirements for two genetic testing codes (0628U for nephrology genetic conditions and 0630U for oncology breast cancer profiling) effective October 1, 2026. All requests must be submitted through Carelon Medical Benefits Management portal.
Action Required
Before October 1, 2026: Billing team must update prior authorization requirements in billing system for codes 0628U and 0630U for Virginia Anthem Blue Cross Blue Shield and Medicare Advantage plans. Train staff to submit authorization requests through Carelon Medical Benefits Management portal at https://providerportal.com or via Availity Essentials. Claims will be denied without proper precertification.