[California] July 2026 Provider Newsletter

By September 19, 2026: (1) Billing team must update benefit verification workflows to account for Blue member ID card logo phase-out—continue verifying benefits through standard channels despite card design changes; (2) Before October 1, 2026: Review updated Carelon Medical Benefits Management clinical appropriateness guidelines (effective September 19, 2026) and precertification/prior authorization requirements (effective October 1, 2026) for Medicare Advantage and Medicaid; (3) By October 1, 2026: Implement new service line limits for Medicare Advantage claims in billing system and train billing staff on updated limits; (4) Review Alerts Hub bulk registration and expanded alert capabilities to improve quality performance reporting for all plans; (5) For Medicaid: Familiarize providers with Critical Care to Home program effective October 1, 2026 and update internal care coordination processes; (6) For Medicare Advantage: Review specialty pharmacy precertification list expansion (effective September 1 and October 1, 2026) and update prior authorization requirements in billing system. Failure to comply with updated prior authorization and service line limits will result in claim denials. Access updated provider manual and clinical guidelines on Anthem provider website.