This form is designed for individuals and organizations wishing to participate in the Anthem Blue Cross Medi-Cal Managed Care Network in California. It includes details about submission and participation criteria. Ensure to complete all required sections accurately for successful submission.

This file provides the reimbursement policy for corrected claims under Medi-Cal Managed Care plans by Anthem Blue Cross. It serves as a guide for providers on the submission of corrected claims and outlines the basis for reimbursement. Understanding this policy is crucial for accurate claims submissions and obtaining timely reimbursements.

This file provides comprehensive instructions for members and prospective members regarding Medi-Cal authorization requests. It includes important contact information and procedural steps for renewal. Utilize this guide to ensure accurate and timely submission of your forms.

This file is a request form for Behavioral Health Out of Network Outpatient Treatment under Anthem Blue Cross Medi-Cal Managed Care. It is used to seek authorization for out-of-network behavioral health services. Complete and submit the form to avoid delays in processing.

This Medi-Cal Managed Care Referral Form is designed for case management referrals for both physical and behavioral health services. It contains detailed sections for referrer and member information. Completing this form accurately ensures appropriate care management support for Medi-Cal members.

The Medi-Cal Choice Enrollment Form is designed for individuals who wish to join or change their health plans under Medi-Cal. This form provides necessary details to ensure correct enrollment. For further assistance, reach out to the California Department of Health Care Services.

This document contains vital information regarding the Medi-Cal coverage renewal process. It provides instructions on how to fill out the renewal form and whom to contact for assistance. Ensure you follow the guidelines to maintain your Medi-Cal benefits without interruption.

This document contains guidelines for submitting corrected claims under Medi-Cal Managed Care policies. It details the requirements for claim submission and reimbursement. Users will find important information regarding proper coding and filing deadlines.

This Medi-Cal Choice Form allows users to join or change their health plans. It provides necessary fields for personal information and health plan selection. Users can find instructions and support for filling out the form to ensure accurate completion.

This PDF contains instructions for requesting a temporary medical exemption from Medi-Cal Managed Care Plan enrollment. It provides essential information for those whose health conditions may worsen if they enroll in a managed care plan. This form is crucial for individuals needing to maintain their regular Medi-Cal doctor.

The Medi-Cal Disclosure Statement is a vital form that providers must complete to ensure enrollment and compliance with Medi-Cal regulations. It provides essential guidelines for accurate and complete disclosure of information. Failure to submit this form correctly may lead to severe consequences, including denial of enrollment or a reapplication bar.

This document provides a referral form for Medi-Cal Managed Care members for both physical and behavioral health case management services. It outlines the necessary information and guidelines for the referral process. Ideal for healthcare providers needing to submit referrals for their patients.