CommercialNovember 1, 2024
Welcome to the Pathway HMO Network
We are pleased to announce our new Pathway HMO fee-for-service network design, Direct HMO. Direct HMO is a grouping of PPO physicians from which members can select a PCP. It applies only to the individual exchange network, Pathway HMO. Read on to learn more about Direct HMO:
- Direct HMO rolls out on January 1, 2025.
- Plan members receive an ID card with Pathway HMO at the bottom right and Direct HMO in the center. Members can also access these cards virtually through the SydneySM Health app.
- The network services the following California counties: Fresno, Kings, Los Angeles, Madera, Orange, Riverside, San Bernardino, and San Diego.
- You can access our online directory, Find Care, at anthem.com/ca to find providers in our Direct HMO network.
- Referrals are required for specialty care except for behavioral health services and other services specified in the member’s Pathway HMO health benefit plan, which members can access directly without a referral (for example, reproductive or sexual health care services and obstetrical/gynecological care consultations as described in the member’s Evidence of Coverage for complete benefit information). Make sure to refer only within the extensive network of Direct HMO specialists.
- For our members with an assigned PCP in Direct HMO, we require all participating plan care providers to follow specific Utilization Management (UM) requirements:
- Promptly notify us of all referral and authorization requests.
- Collaboration with our HMO Clinical Ops Team ensures timely and effective coordination of members’ care needs and guidance to the right in-network care providers.
Questions:
- For specific contract questions, email SpecialNetworkReq@anthem.com with Direct HMO in the subject line.
- For UM or medical management questions, contact our HMO Clinical Ops team. Call toll-free
866-757-8211, fax to 866‑461‑2401, or email hmocomanagement@anthem.com. Please limit questions to medical management only. - For general inquiries, contact our Provider Relations department. For more contact options, please visit anthem.com/ca > Contact Us.
- Our FAQ provides general information about Direct HMO and answers common questions. It will be updated as needed. Please refer to the attached FAQ for details.
We are committed to finding solutions that help our care provider partners offer quality services to our members.
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
CABC-CM-070340-24-SRS70340, CABC-CM-070538-24-SRS70340
ATTACHMENTS: Direct HMO, applicable to Pathway HMO network, effective January 1, 2025 FAQ (pdf - 0.04mb)
PUBLICATIONS: November 2024 Provider Newsletter
To view this article online:
Visit https://providernews.anthem.com/california/articles/welcome-to-the-pathway-hmo-network-22486
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