Benefits of being a Direct HMO provider

Direct HMO is a valuable opportunity in your relationship with us as a care provider. This innovative care model connects our Pathway HMO members with PCPs and specialists from our PPO network. With some differences, you will be able to treat and bill these HMO members like you would for PPO members.

Are you a Direct HMO care provider?

Verifying your participation status is simple. Use the Find Care tool or contact us using the options listed below.

Key benefits of being a Direct HMO care provider

As a Direct HMO specialist, Pathway HMO members will be referred to you. We encourage you to welcome and assist these members:

• You can bill us directly for your services to Pathway HMO members.
• Availity Essentials (https://Availity.com) gives you self‑service access to claim payments or remittances, appeal resolutions, and claim submission statuses. Register at no cost here.
• No referral is needed for visits to urgent care centers (UCC).

To learn more, refer to the FAQ for navigational instructions on Find Care, referral guidance, and completing a Referral and Prior Authorization Request Form.

For more information:

• Contracts: Email SpecialNetworkReq@anthem.com with Direct HMO in the subject line.
• Behavioral health utilization management: Call us toll‑free at 800‑274‑7767.
• Utilization and medical management: Call us toll‑free at 866‑757‑8211.
• General inquiries: Visit the Contact Us page on our provider website.
• Visit the Provider News homepage and search for the key phrase, Direct HMO, to access past newsletters and FAQ.