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[California] Medi-Cal Managed Care fee-for-service transition for members with unsatisfactory immigration status

Anthem BCBS·CA·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 8, 2026
Days to comply
146 days

Summary

Effective January 1, 2027, Anthem Medi-Cal Managed Care members with unsatisfactory immigration status (UIS) will transition to Medi-Cal fee-for-service (FFS) delivery. Providers must be enrolled in Medi-Cal FFS through PAVE by January 1, 2027, to continue serving these members and receive reimbursement. Billing workflows must shift from managed care to FFS processes, including Treatment Authorization Requests (TARs) and FFS-specific billing codes.

Action Required

Before Jan 1, 2027
By January 1, 2027: Billing team must complete the following: (1) Verify provider enrollment in Medi-Cal FFS through PAVE (Provider Application and Validation for Enrollment); if not enrolled, submit application immediately to avoid reimbursement denial. (2) Update billing software and workflows to process Medi-Cal FFS claims instead of managed care claims, including implementation of Treatment Authorization Request (TAR) and eTAR submission processes. (3) Identify and isolate all Anthem Medi-Cal members with UIS status in the EHR/billing system; flag these accounts for FFS billing effective 1/1/2027. (4) Train billing staff on Medi-Cal FFS billing requirements, rate schedules (available at ca.gov Medi-Cal Rates), and care management/case management billing codes listed in policy (CPT 98960-98962, 99424-99427, 99490-99491, 99437, 99439, 99366, 99368, G9012, 99484, 99492-99494, T1017, G0506, and HCPCS G0019, G0022, Z-series, S0197, T1032-T1033 for applicable service lines). (5) Before 1/1/2027, ensure all patient records are handed off with appropriate clinical documentation to continuing providers enrolled in Medi-Cal FFS. (6) Update referral and prior authorization templates to reflect FFS requirements. Contact DHCS Telephone Service Center at 800-541-5555 (Mon-Fri, 8am-5pm) with questions. Failure to enroll in Medi-Cal FFS or update billing processes will result in claim denials and loss of reimbursement for affected members.

Affected Billing Codes

98960
98961
98962
G0019
G0022
59409
59612
59620
59840
Z1032
Z1034
T1033
T1032
Z1038
99424
99425
99426
99427
99490
99491
99437
99439
G0506
99366
99368
G9012
99484
T1017
99492
99493
99494
Z6500
Z6200
Z6202
Z6204
Z6206
Z6208
S0197
Z6300
Z6302
Z6304
Z6306
Z6308
Z6400
Z6402
Z6404
Z6406
Z6408
Z6410
Z6412
Z6414