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[California] Review 2027 provider manual updates
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 26, 2026
Summary
Anthem Blue Cross is updating its California Medi-Cal Managed Care provider manual in January 2027 with operational and regulatory changes affecting behavioral health coordination, community supports, payment methods, credentialing standards, and encounter data requirements. Billing teams must review multiple sections including new prior authorization protocols for behavioral health treatments, revised payment method defaults, updated contact procedures, and compliance with new quality measure standards.
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What to do
by Dec 31, 2026 · 14 steps
01Billing team must review updated provider manual sections at https://providers.anthem.com/ca > Resources > Provider Manuals, Policies & Guidelines and update internal processes accordingly.
02Implement prior authorization requirements for behavioral health treatments including Applied Behavior Analysis (ABA) and Transcranial Magnetic Stimulation (TMS) using empirically-based Care Guidelines for medical necessity determination.
03Update billing system to reflect that providers not enrolled in digital payment methods (EFT, VCC, ZPN) will receive paper checks with potential shift to VCC.
04Remove Short Term Post Hospitalization Housing from Community Supports billing/authorization workflows.
05Update Community-Based Adult Services (CBAS) authorization forms and links in billing system.
06Revise housing support limits from $7,500 to $5,000 per demonstration period in billing records.
07Update contact information: replace fax 866-454-3990 with link to Anthem's Federal Wide Assurance (FWA) reporting site; remove central region LTC fax, retain Los Angeles and Non-Los Angeles fax numbers.
08Update encounter data submission to comply with QMED 2.0 per APL 26-003.
09Review and update credentialing process documentation per revised Anthem Credentialing Policy.
10Configure billing system to comply with new overpayment recovery procedures including repayment, offset against future claims, or third-party collection references.
11Providers and billing staff should verify CNMs and LMs can practice independently without physician supervision per updated scopes of practice.
12Contact Medi-Cal Customer Care: 800-407-4627 (TTY 711) outside L.A.
13County or 888-285-7801 (TTY 711) inside L.A.
14County.
If missed: Failure to implement changes may result in claim denials, authorization delays, and compliance violations.
Original notice
[California] Review 2027 provider manual updates
providernews.anthem.com · Always check the source before changing claims.