Access to new and improved services

Medi-Cal Managed Care (Medi-Cal) members have access to new and improved services that address the whole person – going beyond the doctor’s office or hospital visit to provide care. California Advancing and Innovating Medi-Cal (CalAIM) is a significant opportunity for collaboration between community-based organizations (CBOs), local government agencies, and the Medi-Cal system. People who work in these settings have significant knowledge, expertise, and connections with communities and are skilled at addressing patients’ physical health, behavioral health, and social needs. CalAIM creates an avenue for these organizations to contract with Medi-Cal and be reimbursed for services they have experience providing.

Two major initiatives, Enhanced Care Management (ECM) and Community Supports (CS), are now available to members under the CalAIM umbrella.

Enhanced Care Management

Enhanced Care Management (ECM) provides a whole-person approach to care that addresses the clinical and non-clinical circumstances of a high-need Medi-Cal member. The ECM benefit provides comprehensive care management and achieves better health outcomes for the highest need beneficiaries in Medi-Cal. Learn more about ECM.

ECM eligibility

ECM focuses on specific Populations of Focus (PoFs), serving adults, children, and youth. Anthem Blue Cross (Anthem) members who meet any of the ECM PoFs criteria should be referred to participate.

ECM referrals

Members, ECM providers, community providers, or primary care physicians (PCPs) can refer to ECM. Submit completed ECM Referral Form via:

• Provider website
• Secure email: CalAIMReferrals@anthem.com
• Fax: 877-734-1854
• Customer Care Center: 800-407-4627 (TTY 711) (outside L.A. County)
• Customer Care Center: 888-285-7801 (TTY 711) (inside L.A. County)

ECM authorization process

A referral (authorization request) is ideally submitted to Anthem at the point of care. After submission, the referral is either incomplete, approved, or denied. The standard turnaround time is five business days. In urgent cases, a referrer may request an expedited review, and Anthem will provide a response within three business days of receiving all documentation. In the case of expedited review, Anthem may retroactively start the authorization period up to three days prior to the date that the authorization was approved so that the ECM provider can submit claims for ECM services provided during that period.

Community Supports

Community Supports (CS) are voluntary, flexible, wrap-around services or settings provided by Anthem. They are medically appropriate and cost-effective alternatives to services covered under the state plan. The Department of Health Care Services (DHCS) has approved 14 CS services for individuals with complex physical behavior, developmental, and social needs. Learn more about CS

Community Supports eligibility

Anthem members who meet the criteria of any of the 14 DHCS-approved CS services should be referred to participate.

Community Supports referrals

Members, ECM providers, CS providers, community providers, and PCPs can refer to CS. Submit completed CS Referral Forms:

• Provider website
• Secure email: CalAIMReferrals@anthem.com
• Fax: 877-734-1857
• Customer Care Center: 800-407-4627 (outside L.A. County)
• Customer Care Center: 888-285-7801) (inside L.A. County)

A referral (authorization request) is ideally submitted to Anthem at the point of care. After submission the referral is either incomplete, approved, or denied. The standard turnaround time is five business days. In urgent cases, the referrer may request an expedited review and Anthem will provide a response within three business days of receiving all documentation.

Enhanced Care Management or Community services questions?

If you have questions about ECM or CS technical support, contact:

• L.A. County: teresa.samuels@anthem.com
• Northern California michele.ellington@anthem.com
• Central California: Rolando.reyes@elevancehealth.com

Contracted ECM providers with non-technical questions should contact their assigned Practice Transformation liaison.

Join CalAIM

If you are interested in becoming a CalAIM provider or have other CalAIM questions, email CalAIM@anthem.com.]More information about CalAIM and other supporting programs from Anthem can be found at: California Provider - Anthem Blue Cross.