All PlansDocumentationMedium impact

[California] Enhancing claims accuracy for inpatient sepsis and some newborn DRG submissions with full medical records

Q: Who is affected by this change?

This affects Anthem BCBS Critical Care, Emergency Medicine, Pediatrics, Infectious Disease providers in CA on All Plans plans.

Anthem BCBS·CA · Critical Care, Emergency Medicine, Pediatrics +1 more·Coding

Effective date

Not stated

We identified it

May 3, 2026

Days to comply

—

Summary

Anthem California is now requiring full medical records submission for inpatient sepsis and certain newborn DRG claims to improve claims accuracy. This change affects hospitals and practices that submit inpatient claims for these specific conditions.

Action Required

Action needed

Immediately: Billing teams must submit complete medical records with all inpatient sepsis and specified newborn DRG claims to Anthem California. Update claim submission workflows to include full documentation package. Incomplete submissions may result in claim delays or denials.

Related policy hubs

Anthem BCBS policies CA policy changes Critical Care Emergency Medicine Pediatrics Infectious Disease