Anthem Blue Cross : Prenatal Program

Prenatal Program

When it comes to our pregnant members, we are committed to keeping both mom and baby healthy. That’s why we encourage all of our moms-to-be to take part in our New Baby, New Life℠ program — a comprehensive case management and care coordination program that offers: 
Individualized, one-on-one case management support for women at highest risk
Care coordination for moms who may need a little extra support
Educational materials and information on community resources
Incentives to keep up with prenatal and postpartum checkups and well-child visits after the baby is born
An important component of the prenatal program is the early identification of pregnant women. When you know a patient is pregnant, complete the Pregnancy Notification Report Form (PNR) immediately after the patient’s visit and return it to us by fax at 1-855-410-4451. 
All identified pregnant women are automatically included in the New Baby, New Life℠ program. An OB high risk assessment to determine the level of case management support mom may need during her pregnancy is completed. A prenatal packet is sent that includes information on planning a healthy pregnancy, resources related to pregnancy, information on the importance of prenatal visits, and other related topics and incentive offerings for attending prenatal visits.  
Once your patient delivers, she will also receive a postpartum packet with information on postpartum care, well-child care, postpartum depression, and other related topics and incentive offers for attending their postpartum visit within 21-56 days and for well-child visits in the first 15 months. In addition, our program offers your patient prenatal, breastfeeding, and parenting classes through referrals to local community classes. We will also remind her to get a postpartum exam and give her a gift card incentive when she gets the exam within 21 to 56 days after childbirth.  
Prenatal Toolkit 

Pregnancy Notification Report Form (PDF)

Pregnancy Assessment Form: Initial (DOC)

Pregnancy Assessment Form: 2nd Trimester (DOC)

Pregnancy Assessment Form: 3rd Trimester (DOC)

Steps to take for Primary Care Physicians and Obstetricians
Steps to take:  
Confirm a diagnosis of pregnancy Anthem Medi-Cal Managed Care (Medi-Cal) members.
Orient the Medi-Cal patient to the comprehensive perinatal services program (CPSP), advise what services are available, and document the patient's acceptance or refusal.
If the patient accepts CPSP, you can provide the services or refer out to a source. Ask for copies of the assessments to put into the patient's chart.
SB 889 requires every provider of prenatal care to offer HIV counseling and testing to every pregnant woman during her prenatal care. The law requires documentation that patients were offered HIV counseling, testing and information. Please document in the patient's chart.
Refer the patient to the Women, Infant, and Children (WIC) supplemental nutrition program.
Refer the patient at 1-888-285-7801 to register for a Prenatal, Breastfeeding, and/or Childbirth class.
Complete a Pregnancy Notification Report and fax to 1-855-410-4451.
Customer Care Associates may now ask you for the prenatal information over the phone during routine customer service calls.
If the patient's pregnancy becomes high risk at any time during her prenatal care, please notify Anthem at 1-866-595-0145.
If a patient has questions about lactation or breastfeeding please refer them to Anthem Breastfeeding Support Line at (800) 231-2999. A registered nurse is available 24 hours a day, 7 days a week to answer questions and provide support.
Breastfeeding Promotion
Anthem supports the Department of Health Services policy (MMCD Policy Letter 98-10) regarding promotion, education, counseling and provision of medically necessary breastfeeding related services. The following points summarize the policy for breastfeeding education and counseling and the provision of medically necessary breastfeeding related services.  

Breastfeeding is recognized as the preferred method of infant feeding by the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the American Public Health Association.

Breastfeeding should be encouraged for all pregnant women unless it is not medically appropriate.

Providers must refer all Anthem Medi-Cal pregnant and breastfeeding members to the Women, Infants, and Children (WIC) Supplemental Nutrition Program in their area.

Pregnant members should be referred to Anthem breastfeeding classes prior to delivery by calling Anthem Member Services at (888) 285-7801 for LA County and (800) 407-4627 for all other counties.

Providers may not provide formula samples, coupons, or materials from infant formula companies to Anthem breastfeeding or pregnant members.

All materials given to patients should be screened for negative or contradictory messages about breastfeeding.

Lactation management aids are a covered benefit for Anthem Medi-Cal members. Hand held breast pumps can be obtained via prescription without prior authorization.

Electric breast pumps are available for medical necessity for Anthem Medi-Cal members with a provider referral and prior authorization. Contact the Utilization Management Department at (888) 831-2246 to confirm if prior authorization is required.

Arrangement for the provision of human milk for newborns must be made if the mother is unable to breastfeed due to medical reasons, and the infant cannot tolerate or has medical contra-indications to the use of any formula, including elemental formulas. The Mother's Milk Bank of Santa Clara Valley Medical Center is the only human milk bank in the State of California. The Mother's Milk Bank can be contacted at 1-877-375-6645.

Importance of Breastfeeding
1. Human milk is uniquely suited for human infants.  

Human milk is easy to digest and contains all the nutrients that babies need in the early months of life.

Breast milk contains factors that help infants grow and mature.

Factors in breast milk protect infants from a wide variety of illnesses.

Breast milk contains antibodies specific to illnesses encountered by each mother and baby.

Fatty acids, unique to human milk, may play a role in infant brain and visual development.

In several large studies, children who have been breastfed had a small advantage over those who have been artificially fed when given a variety of cognitive and neurological tests, including measures of IQ.

2. Breastfeeding saves lives.  

Lack of breastfeeding is a risk factor for sudden infant death syndrome (SIDS).

Human milk may protect premature infants from life-threatening gastrointestinal disease.

3. Breastfeeding infants are healthier.  

Infants who are exclusively breastfed for at least 4 months are half as likely as artificially (milk or milk substitute other than mothers’ milk) fed infants to have ear infections in the first year of life.

Breastfeeding reduces the incidence and lessens the severity of bacterial infections such as meningitis, lower respiratory infections, and bacteremia in infants.

Breastfeeding is protective against infant botulism.

Evidence suggests that exclusive breastfeeding for at least two months protects susceptible children from Type I insulin dependent diabetes mellitus (IDDM).

Breastfeeding may reduce the risk for subsequent inflammatory bowel disease and childhood lymphoma.

Breastfed infants are less likely to have diarrhea.

Women who were breastfed as a child are less likely to develop multiple sclerosis.

4. Breastfeeding helps mothers recover from childbirth.  

Breastfeeding helps the uterus shrink to its pre-pregnancy state and reduces blood loss after delivery.

Mothers who breastfeed for at least three months may lose more weight than bottle-feeding mothers.

Breastfeeding mothers usually resume their menstrual cycles 20 to 30 weeks later than bottle-feeding moms.

5. Breastfeeding keeps women healthier throughout their lives.  

Breastfeeding reduces the risk of breast and ovarian cancer.

Breastfeeding may reduce the risk of osteoporosis.

During lactation, total cholesterol, LDL cholesterol, and triglyceride levels decline while the beneficial HDL cholesterol level remains high.

6. Breastfeeding is economical.  

The cost of artificial milk has increased 150 percent since the 1980s.

If no California infants were breastfed, the cost of artificial baby milk would exceed $400 million per year.

Breastfeeding reduces health care costs.

7. Breastfeeding is environmentally sound.  

Unlike artificial baby milk, breastfeeding requires no fossil fuels for its manufacture or preparation.

Breastfeeding reduces pollutants created as by-products during the manufacture of plastics and artificial baby milk.

Breastfeeding reduces the burden on our landfills.

Breastfeeding Promotion Committee Report to the California Department of Health Services Primary Care and Family Health  
Women, Infants, and Children (WIC) Program
The California Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a supplemental food and nutrition education program. It serves low-income pregnant, breastfeeding, and postpartum women, and infants and young children who are at nutritional risk.  
The purpose of the WIC program is to prevent health problems and to improve the health of program participants during critical times of growth and development. It is unique among federally administered food assistance programs because it provides specific supplemental nutritious food and nutrition education to a specific target population as an adjunct to ongoing health care.  
The WIC prescreening tool link below can be used to determine if a member may be eligible for WIC benefits. This prescreening tool is not an application for WIC. To apply for WIC benefits, you must make an appointment at your WIC local agency. 
Referral forms can be requested from local WIC agencies or by calling the State WIC Branch at 1-888-942-9675.  
Thank you for continuing to provide quality health care for our members.  

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