Reimbursement Policies

We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member's Medi-Cal Managed Care or Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan/MMP) plan.

Keep in mind that determination of coverage under a member's benefit plan does not necessarily ensure reimbursement.

These reimbursement policies serve as a guide to assist you in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s benefit plan. The determination that a service, procedure, or item is covered under a member's benefit plan is not a determination that you will be reimbursed. Services must also meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis, as well as to the member’s state of residence.

Reimbursement policy disclaimer 

Reimbursement policy definitions