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[Georgia] SSBCI eligibility requirements and care provider requests for our members
Act
by Oct 1, 2026
Effective date
Oct 1, 2026
Identified
Oct 2, 2026
Summary
Anthem Blue Cross and Blue Shield (Georgia) has updated Special Supplemental Benefits for the Chronically Ill (SSBCI) eligibility requirements effective October 1, 2026. Members must now meet three CMS criteria and be validated through claims history or clinician attestation using a standardized form. The policy establishes specific Clinical Guidelines including chronic condition diagnosis, recent hospitalizations, ER/urgent care visits, outpatient visits, home health needs, functional impairments, or DME requirements.
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What to do
by Oct 1, 2026 · 6 steps
01Clinical teams must begin collecting SSBCI attestation forms from eligible members prior to their initial enrollment date.
02Forms should be distributed in pre-enrollment kits and completed by care providers (participating or non-participating).
03Billing and eligibility staff must establish process to validate member eligibility through either claims history review or clinician-completed attestation forms before members can access SSBCI benefits (healthy foods, utilities).
04Create intake workflow to route completed forms to Anthem via fax, Availity Essentials portal (https://Availity.com), or oral attestation through Provider Services.
05Train billing staff on the six Clinical Guidelines qualifying pathways: inpatient admissions, ER/urgent care visits, 2+ outpatient visits, home health needs, ADL/cognitive impairments, or specific DME requirements (power wheelchairs, NIV, wound vacs, BiPAP, mechanical in-exsufflation, group 2-3 mattresses).
06Update member communication materials and provider encounter forms to reference the qualifying chronic conditions listed in Evidence of Coverage.
If missed: Failure to complete attestation will delay member access to SSBCI benefits and delay claims processing for supplemental services.
Codes mentioned
E0607E0601E1390E0466E0468K0861K0862K0863
Original notice
[Georgia] SSBCI eligibility requirements and care provider requests for our members
providernews.anthem.com · Always check the source before changing claims.
Related changes
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