Direct HMO: understanding the network design

Direct HMO is a new provider option for our Anthem Blue Cross Pathway HMO members, comprised of PCPs and specialists from our PPO network who treat and bill for HMO members in the same way they do for PPO members. There are just a few differences, and we are committed to empowering our care providers with comprehensive education about this opportunity, ensuring sustained success for our members and care provider partners.

Are you a Direct HMO provider?

To verify your participation status, please use the Find Care tool or contact us for more information using the appropriate option below.

A few reminders:

• Referrals by a Direct HMO PCP are required for specialty care. Refer to the FAQ for specific navigational instructions to guide your search.
• No referral is needed for visits to urgent care centers.
• To request preapproval, complete the Referral and Prior Authorization Request Form and fax it, along with any required documents, to 866‑461‑2401. Please do not use Availity Essentials for Direct HMO requests.
• The Referral and Prior Authorization Request Form includes detailed instructions to help you complete it accurately and avoid delays.
• Care providers can easily coordinate care by contacting our HMO Clinical Operations team toll‑free at 866‑757‑8211.

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 at https://www.anthem.com/ca/provider/individual-commercial/contact-us.

Visit the Provider News homepage and search for the key phrase Direct HMO to access past newsletters and FAQ and learn more about our Direct HMO providers.