CommercialAdministrativeMedium impact
[California] Weekly authorization and denial log submission required for HMO risk providers — impacts claims accuracy and compliance
Anthem BCBS·CA·Provider Bulletin
Effective date
Jul 15, 2026
We identified it
Jun 1, 2026
Summary
Anthem is implementing a new weekly authorization and denial log submission requirement for all HMO risk provider groups (Shared Risk, Dual Risk, and Full/Global Risk) in California, effective July 15, 2026. Provider groups must submit these logs via Anthem's secure EFX server to ensure accurate member cost sharing and claims processing. This requirement is separate from the existing annual Delegation Oversight Audit submission.
Action Required
By July 15, 2026: HMO risk provider groups must establish weekly submission process for authorization and denial logs via Anthem's secure EFX server. Administrative staff should: (1) Contact provider relationship management representative to receive EFX server connection details and Excel template sample; (2) Configure internal systems to compile and export authorization/denial data weekly; (3) Review updated HMO Provider Manual section titled 'Authorization Log and Denial Log Submission' at www.anthem.com/ca (Resources > Policies, Guidelines & Manuals > HMO Manual); (4) Establish weekly submission schedule to avoid claims processing delays and ensure member cost shares are applied correctly. Failure to submit weekly logs may result in inaccurate claims processing and payment delays.