Reminder: Direct HMO is coming January 2025

We want to remind you of the important announcement about Direct HMO, featured in our November newsletter. This new Pathway HMO (on and off exchange products) fee-for-service network design will officially launch on January 1, 2025.

Here's what you need to know:

• ID cards: Members will get an ID card marked Pathway HMO at the bottom right. In the center, the card will display Direct HMO and the name of their assigned Direct HMO PCP. They can also access their cards virtually through the Sydney^SM Health app.
• Updated coverage area: Pathway HMO plans, including Direct HMO as of January 1, 2025, will serve Los Angeles, Riverside, San Bernardino, Orange, and San Diego counties in California.
• Provider Directory: Utilize our online directory, Find Care, at anthem.com/ca to locate providers in the Direct HMO network.
• Referrals: Required for specialty care (except for behavioral health and other specific services to the extent outlined in the member’s plan (for example, reproductive or sexual healthcare services, and obstetrical/gynecological care consultations as described in the member’s Evidence of Coverage for complete benefit information). Make sure to refer only to the extensive network of Direct HMO specialists.
• Utilization management: Coordinate all non-urgent and emergent services with Pathway HMO contracted providers. To ensure smooth care coordination, work with our HMO Clinical Operations Team for effective care coordination on all referral and authorization requests.
• Updated FAQ: The FAQ document has been updated and includes a December date in the footer. Always refer to the most current version for the latest information and guidance.

For more information read the detailed November newsletter article or contact us directly:

• Contract questions: Email SpecialNetworkReq@anthem.com with Direct HMO in the subject line.
• Behavioral health utilization management: Call toll-free 800-274-7767.
• Utilization/medical management: Call toll-free 866-757-8211, fax 866-461-2401, or email hmocomanagement@anthem.com.
• General inquiries: Visit anthem.com/ca > Contact Us.

Thank you for working together in delivering high-quality care to our members. Stay informed and prepared for the exciting rollout of Direct HMO.