ExchangeAdministrativeMedium impact
[California] EMR alerts aim to close gaps in care for Affordable Care Act members
Anthem BCBS·CA·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 3, 2026
Summary
Anthem Blue Cross is implementing EMR alerts to identify care gaps for ACA plan members, requiring providers to review notifications, address documented gaps, and submit claims with high-specificity coding and complete clinical data. This is an informational directive to support proactive care management and ensure compliance with ACA program reporting requirements.
Action Required
By May 1, 2026: Providers and billing staff must review EMR alerts from Anthem for ACA-covered patients and ensure care gaps are addressed with appropriate clinical documentation. Billing team must verify that all claims submitted include the highest specificity of coding and complete clinical data reflecting patient health status. Providers should schedule timely follow-up visits for patients with chronic or previously documented conditions flagged by alerts. Direct questions regarding the alert system to Anthem's Commercial Risk Adjustment team at prospectiveteam@anthem.com. Failure to address care gaps and document appropriately may impact compliance with ACA program reporting requirements.