MedicaidAdministrativeLow impact
[California] Essential UM guidelines for timely service preapproval and reimbursement
Anthem BCBS·CA·Claims & Billing
We identified it
May 9, 2026
Summary
This is an informational policy update from Anthem Blue Cross (California Medicaid/Medi-Cal) clarifying existing utilization management (UM) processes, preapproval submission methods, and contact procedures. No changes to prior authorization requirements, coverage rules, or billing codes are introduced—this reinforces current guidelines for timely service preapproval and reimbursement.
Action Required
No immediate action required. Billing team should review contact information and submission methods for reference: Availity Essentials (https://Availity.com), fax to 800-754-4708, or phone 888-831-2246 option 3 for preapproval requests. Ensure staff are aware that UM decisions are based on medical necessity and that providers can discuss denials with physician reviewers. This is a reference document, not a policy change.