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[California] Medi-Cal Managed Care fee-for-service transition for members with unsatisfactory immigration status
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Aug 8, 2026
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.
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What to do
by Jan 1, 2027 · 8 steps
01Billing team must complete the following.
02Verify provider enrollment in Medi-Cal FFS through PAVE (Provider Application and Validation for Enrollment); if not enrolled, submit application immediately to avoid reimbursement denial.
03Update 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.
04Identify 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.
05Train 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).
06Before 1/1/2027, ensure all patient records are handed off with appropriate clinical documentation to continuing providers enrolled in Medi-Cal FFS.
07Update referral and prior authorization templates to reflect FFS requirements.
08Contact DHCS Telephone Service Center at 800-541-5555 (Mon-Fri, 8am-5pm) with questions.
If missed: Failure to enroll in Medi-Cal FFS or update billing processes will result in claim denials and loss of reimbursement for affected members.
Codes mentioned
989609896198962G0019G002259409596125962059840Z1032Z1034T1033T1032Z10389942499425994269942799490994919943799439G05069936699368G901299484T1017994929949399494Z6500Z6200Z6202Z6204Z6206Z6208S0197Z6300Z6302Z6304Z6306Z6308Z6400Z6402Z6404Z6406Z6408Z6410Z6412Z6414
Original notice
[California] Medi-Cal Managed Care fee-for-service transition for members with unsatisfactory immigration status
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →Related policy hubs
Anthem BCBS policiesCA policy changesCode 98960Code 98961Code 98962Code G0019Code G0022Code 59409Code 59612Code 59620Code 59840Code Z1032Code Z1034Code T1033Code T1032Code Z1038Code 99424Code 99425Code 99426Code 99427Code 99490Code 99491Code 99437Code 99439Code G0506Code 99366Code 99368Code G9012Code 99484Code T1017Code 99492Code 99493Code 99494Code Z6500Code Z6200Code Z6202Code Z6204Code Z6206Code Z6208Code S0197Code Z6300Code Z6302Code Z6304Code Z6306Code Z6308Code Z6400Code Z6402Code Z6404Code Z6406Code Z6408Code Z6410Code Z6412Code Z6414