Medicare AdvantageAdministrativeHigh impact
[California] 2026 California EAE DSNP Quick Reference Guide
Anthem BCBS·CA·Provider Bulletin
Effective date
May 1, 2025
We identified it
May 19, 2026
Summary
Anthem is launching the 2026 California EAE DSNP (Exclusively Aligned Enrollment Dual Eligible Special Needs Plan) in 16 counties, integrating Medicare and Medi-Cal Managed Care under one plan. Billing teams must use network IDs CAEAEDSNP001 (Medicare primary) and CADUALCAID01 (Medi-Cal secondary), submit single claims with one member ID for both Medicare and Medicaid services, and recognize that care providers were pre-enrolled from existing Medicare PPO networks effective May 1, 2025.
Action Required
REQUIREMENTS: By September 30, 2026 and annually thereafter: Billing team must update claim submission processes to recognize CAEAEDSNP001 (Medicare) and CADUALCAID01 (Medi-Cal) network IDs for Anthem Full Dual Advantage Aligned HMO D-SNP members in CA counties (Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Los Angeles, Madera, Mono, Sacramento, San Francisco, Santa Clara, Tulare, Tuolumne). Immediately: (1) Update billing software to process single claim submissions containing one Anthem-issued member ID for both Medicare and Medicaid services—do NOT submit separate Medicaid claims as claims will be denied; (2) Train all billing and revenue cycle staff that care providers must coordinate with Anthem for authorization of LTSS, CS, and CBAS services; (3) Update referral management protocols to reflect that directly contracted PCPs manage their own referrals, while IPA/PMG-affiliated PCPs must follow their entity's referral rules; (4) Verify that all provider credentials in billing system reflect Anthem network participation effective May 1, 2025. By October 15, 2026: Billing team must prepare to receive new member ID cards and be prepared to update records. Before processing any claim for these members: Confirm member eligibility as full dual eligible (QMB+, SLMB+, or other full dual categories)—partial dual eligible beneficiaries are NOT eligible for EAE D-SNP and will be disenrolled. Failure to submit unified claims with correct network IDs will result in claim denials and delayed reimbursement.