Medicare AdvantageDocumentationMedium impact
[California] C‑SNP verification required for care providers: confirm conditions to prevent member disenrollment
Anthem BCBS·CA · Cardiology, Endocrinology, Pulmonology +4 more·Provider Bulletin
Effective date
Apr 22, 2026
We identified it
May 3, 2026
Summary
Anthem is requiring care providers to verify C-SNP (Chronic Special Needs Plan) member qualifying conditions within 5 days of outreach to prevent member disenrollment. Providers must respond to verbal confirmation attempts or complete and return faxed C-SNP Verification Forms promptly. This is separate from SSBCI attestation and applies to members with chronic heart failure, cardiovascular disease, diabetes, chronic lung disorders, or chronic kidney disease.
Action Required
By May 22, 2026 (within 5 days of Anthem outreach): Billing and clinical staff must establish a process to respond to C-SNP verification requests from Anthem. Designate staff to monitor for verbal confirmation calls and faxed C-SNP Verification Forms. Complete and return all verification forms to the Membership Department fax number within 5 calendar days. Train front desk and clinical staff to recognize C-SNP verification requests and distinguish them from SSBCI attestation requests. Document the member's qualifying condition (CHF, cardiovascular disease, diabetes, chronic lung disorder, or CKD stages 1-5) in the patient record to support verification. Failure to respond within 5 days will result in member disenrollment at the end of the second month, affecting claims processing and member coverage continuity.