Effective January 1, 2018, Anthem Blue Cross (Anthem) will update codes with a set rate per unit to the HIPAA-compliant, HCPCS “A” and “B” codes for medical supplies, which include enteral/parental products and formulas. Set rates for these codes will eliminate the need for an invoice, universal product number (UPN) or medical billing number (MBN) requirements.

 

Previous requirements entailed adding UPN on the claim line with “A” codes, adding MBN with “B” codes for enteral/parental product(s) on the claim line, or attaching an invoice or catalog page to the claim line to price. This is now eliminated.

 

New billing instructions

Do not attach an invoice or catalogue page to the claim line. Providers supplying members with medical supplies, including enteral/parenteral products and formulas, are not required to submit an invoice, UPN or MBN to receive payment.

 

Authorization and claim submission

  • For Medi-Cal Managed Care (Medi-Cal) members, medical supplies may be a capitated service from independent practice associations (IPAs) or primary medical groups (PMGs). A member’s ID card will indicate which IPA/PMG to contact for possible authorization, claim submission and reimbursement criteria. If there is no IPA contact information, contact Anthem using the phone number on the back of the member’s ID card for possible authorization and claim submission information.

  • For Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) members, Anthem is responsible for medical supplies. This is a traditional Part B service. Possible authorizations and benefits should be coordinated directly with Medicare as applicable. Contact Utilization Management using the phone number on the back of the back of the member’s ID card for possible authorization criteria and claim submission addresses.

The following “A” and “B” codes are current benefits and should be billed specifically for the description of each code. Only the codes listed for medical supplies including enteral/parenteral products should be reimbursed. Open the attachment to view the current list. This list may be updated periodically. 



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June 2019 Anthem Blue Cross Provider Newsletter - California