Help your patients continue their care and navigate Medicaid renewal

During the COVID-19 public health emergency, Medicaid and Children’s Health Insurance Program (CHIP) members were able to stay enrolled in their current health coverage regardless of changes in eligibility or status. As Medicaid renewals begin again, your Medicaid and CHIP patients may have to take additional steps, which could include finding a new health plan. 

Patients who are receiving specialized care for medical conditions such as but not limited to pregnancy, chemotherapy, radiation therapy, or behavioral health therapy, may have additional concerns. They could be in the middle of treatment, scheduled for treatment, or on maintenance medications — and may be worried that they might lose access to their current care provider if they change health plans.

The need for continuity of care in this changing landscape

We’re committed to ensuring a smooth transition for your Medicaid and CHIP patients who are changing   health plans. 

Our Continuity of Care/Transition of Care management team coordinates with you and your patients to ensure access to ongoing care. This includes a personalized evaluation of the member’s condition and network benefits to coordinate and minimize disruption of ongoing care: 

• Your patients can contact the number on the back of their member ID card and ask about our Transition of Care form. Once filled out, one of our dedicated nurse care managers will contact them to review their specialized care needs within 15 business days.
• Download our provider manual to learn more about our Continuity of Care/Transition of Care Program. Refer to the table of contents and find Continuity of Care/Transition of Care Program under the Quality Improvement Program section.

A proactive approach to prior authorizations

For patients with CarelonRx, Inc.* as their pharmacy benefit manager and who are on maintenance medications or other medications for treatment, their existing, approved prior authorizations will automatically transfer to their new Anthem Blue Cross and Blue Shield (Anthem) individual and family health plan, and there will be a one-time prior authorization applied for nonformulary medications. 

This will allow your patients to continue to fill their current medications and allow additional time to initiate the prior authorization process for any formulary differences. 

You and your patients can count on us for support

Your patients who are receiving specialized care may have concerns about continuing their care and staying with their current care providers. We want you to feel confident you have resources and answers to guide them.

Together, we can ease your patients’ potential concerns and ensure a smooth transition for those who choose an Anthem individual and family health plan. 

If you would like more information, contact your Provider Relationship Management representative, or call the number on the back of the patient’s ID card.