Medicare AdvantageAdministrativeMedium impact
[California] Continued collaboration on DRG clinical and coding validation
Anthem BCBS·CA·Coding
We identified it
Jul 23, 2026
Summary
Anthem Blue Cross will continue conducting DRG clinical and coding validation audits through its Complex and Clinical Audit (CCA) team and external vendors (EXL and Ceris) for Medicare Advantage and Medi-Cal Managed Care plans in California. Providers should expect ongoing medical record requests and audit correspondence; the process remains consistent with efforts to minimize duplicate requests.
Action Required
Immediately: Billing and clinical teams should ensure processes are in place to respond promptly to medical record requests from Anthem's CCA team and designated vendors (EXL and Ceris). Designate a staff member to track and coordinate medical record submissions to minimize delays. Maintain organized documentation systems to support rapid DRG validation audit responses. While this is a continuation policy, verify your practice's current audit response procedures are adequate and documented. Contact your Anthem provider relationship management representative if you have questions about audit protocols or vendor correspondence.