[California] March 2026 Provider Newsletter

REQUIREMENTS: - By May 1, 2026: Billing team and clinical staff must review the complete newsletter at https://providernews.anthem.com/california/publications/march-2026-provider-newsletter-5309 to identify plan-specific changes affecting your practice. - By May 15, 2026: Update billing system and prior authorization workflows to reflect precertification/prior authorization requirement changes for Medicaid plans (effective June 1, 2026). Update encounter forms and staff protocols accordingly. - By May 15, 2026: Implement MCG Care Guidelines 30th edition in clinical decision support tools for Medicare Advantage and Medicaid plans (effective June 1, 2026). Ensure providers and billing staff are trained on new clinical criteria. - By May 15, 2026: Review pharmacy prior authorization and step therapy updates for medications billed under medical benefit for Medicaid plans (effective June 1, 2026). Update pharmacy benefit verification protocols. - By June 1, 2026: Verify all systems reflect Clinical Criteria updates for Medicaid (effective May 21, 2026). - Immediately: Document corrected claims procedures per February 6, 2026 reminder for all Commercial claims submissions. - Immediately: Confirm reimbursement is allowed for Assistant Surgery payment indicator 2 (per February 5, 2026 update) for Commercial plans. - By April 1, 2026: Verify January 1, 2026 formulary deletions for Commercial pharmacy billing. Failure to implement prior authorization changes and clinical guideline updates by effective dates will result in claim denials and reduced reimbursement.