Login
Access your personalized employer services.

Login
Find a Doctor
Need to find a Doctor or Hospital? Check the Online Provider Directory.

Enter
360° Health®
A total-health solution that surrounds everyone with the help they need to live healthier, feel better and save money doing it.

Enter
Anthem Blue Cross : State Sponsored Plans

State Sponsored Plans

PW_A112596

Provider Resources

AB 97 Trailer Bill Changes That May Affect You 
In March 2011, the California legislature passed Assembly Bill 97 (AB 97), which reduces reimbursement rates to providers for Medi-Cal and Healthy Families Program. In addition, AB 97 implements new copays for some services, raises existing member copay amounts for others and reduces or eliminates certain benefits. The state announced that by passing AB 97 it intends to save approximately $1.7 billion in expenditures on these state-funded programs.  
Implementation of AB 97 required approval by the Centers for Medicare & Medicaid Services (CMS). CMS recently approved the AB 97 rate reductions. We want to alert our valued providers that we will be contacting you, by mail, soon with updates to our fee schedules based on the information we have received from the state.  
If CMS also approves the AB 97 copays and benefit limitations, Anthem Blue Cross will respond with appropriate changes to copays and benefit limitations for our members. Please watch for additional communications on the effect of AB 97.  
Thank you for your patience as we implement the necessary requirements. 
 
Provider Training  
CBAS Frequency Tool Orientation
CBAS Provider Toolkit
McKesson ClaimsXtenTM Rules
EDI/HIPAA 5010: Click here for the latest information on HIPAA 5010 so you can be ready on January 1, 2012
Tour our Provider Website for the Latest Information
Resource Library for Office Improvements
LTSS Provider Orientation
 
Program Information  
Medi-Cal
Medi-Cal and Medi-Cal Expansion Professional Fee Schedule
Medi-Cal Hospital Outpatient Fee Schedule
Medi-Cal Free Standing Outpatient Fee Schedule
Healthy Families Program to Medi-Cal Transition
Major Risk Medical Insurance Program (MRMIP)
Access for Infants and Mothers (AIM)
Path2Health and County Medical Services Program (CMSP)
Long Term Services and Supports
 

Quality Improvement Program 
Date 
Format 

Provider Credentialing Program

01/10

PDF

QIP Summary

06/12

PDF

Medical Records Documentation Standards

11/13

PDF

20 Principles of Customer Care

11/09

PDF

Clinical Practice Guidelines

-

HTML

Preventive Health Care Guidelines

-

HTML

Behavioral Health Clinical Practice Guidelines

 

HTML

State-approved facility site review and medical record review tools. The following State required tools became effective 2/1/2012.

   
Physical Accessibility Review Survey

02/12

Word

Medical Record Review Survey 2012

02/12

PDF

Site Review Survey 2012

02/12

PDF

 

Prior Authorization and Preservice Review 
Date 
Format 

UM Clinical Guidelines

06/24/13

PDF

Services Requiring Prior Authorization – Effective August 1, 2013

07/13 

PDF

Services Requiring Prior Authorization (Path2Health and CMSP)

11/30/11

PDF

Request for Preservice Review

02/19/08

PDF

Request for Preservice Review (MRMIP)

02/19/08

PDF

Request for Preservice Review (Path2Health and CMSP)

11/15/11

PDF

 
Please contact the UM intake department for any questions on prior authorization at:  

Medi-Cal and Healthy Families - phone 888-831- 2246 or fax 800 -754- 4708

MRMIP, AIM, &CMSP - phone 877-273-4193 or fax 800- 754- 4708

 

Health Education 
Date 
Format 
   

Caring for Diverse Populations

08/13

PDF

Language Assistance Program Quick Reference Guide

01/11

PDF

Employee Language Skills Self-Assessment Tool (Inside L.A. County)

08/10

PDF

Employee Language Skills Self-Assessment Tool

9/12

PDF

EPSDT Information

-

HTML

Teen Health Letter from Doctor
Suggested language for your use to place on your letterhead, to mail to parents and guardians of your teen patients.

02/10

DOC

Health Education Resources

-

HTML

Free Interpreting Services

-

HTML

Prenatal Program

-

HTML

WIC Program Forms and Information

-

HTML

CHDP Periodicity Schedule for Health Assessment Requirements by Age Groups

09/07

PDF

 

Provider Communications 
Date 
Format 

Provider Manuals and Important Updates

-

HTML

Provider Newsletters

-

HTML

 

Additional Programs and Services 
Date 
Format 

Pharmacy – AIM

-

HTML

Pharmacy – MediCal

 

HTML

Pharmacy – MRMIP

 

HTML

Telehealth

-

HTML

 

Forms and Tools 
Date 
Format 

03/19/14

PDF

-

HTML

04/12

PDF

01/01/12

PDF

 

PDF

Forms Library

-

HTML

Desktop IVR Reference Guide

03/09

PDF

Medi-Cal Capitated Groups Contact List

09/12/12

PDF

Path2Health and CMSP Important Contact Information

11/30/11

PDF

Member Rights and Responsibilities
Please refer to the Provider Manual, Chapter 10: Members Rights and Responsibilities

 

PDF

 

Standards and Policies 
Date 
Format 

Advance Directives

12/22/09

PDF

HIPAA Readiness Disclosure Statement

05/20/09

PDF

 

Contracting 
Date 
Format 
 
PDF  

CMS Ownership Disclosure Form

02/02/10

PDF


® Anthem is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association © 2011 Anthem Blue Cross.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.