Anthem Blue Cross

Providers - California

Pregnancy and Maternal Child Services


New Baby, New LifeSM

The New Baby, New Life program is a comprehensive proactive case management and care coordination program for all expectant mothers and their newborns. All identified pregnant patients are automatically included in the program. It offers:

  • Individualized, one-on-one case management support for women at the highest risk.
  • Care coordination for moms who may need a little extra support.
  • Educational materials and information on community resources.
  • Incentives to help keep up with prenatal exams, postpartum checkups, and well-child visits after the baby is born.

This program helps us to identify and support pregnant women as early in their pregnancies as possible. Once pregnant members are identified, we act quickly to assess any obstetrical risk and ensure appropriate levels of care and case management services to mitigate risk. 

Please note that Anthem Blue Cross (Anthem) requires notification of pregnancy after the first prenatal visit and notification of delivery following birth

  • You may choose to complete the notifications of pregnancy and delivery in the online Interactive Care Reviewer (ICR) or via fax
  • If sending via fax, see the Forms section below for the Notification of Pregnancy Form. Fax the completed form to Anthem at 1-833-410-4451

We also encourage providers to complete the Maternity Module in Availity:

  • Perform an Eligibility and Benefits request on an Anthem member,
  • Choose one of the following benefit service types: Maternity, Obstetrical, Gynecological, Obstetrical/Gynecological,
  • Before the benefit results screen, you will be asked if the member is pregnant. Choose “Yes,” if applicable, and note the estimated due date. You can leave this blank if the due date is unknown.

After submitting your answer, you’ll be taken to the member’s benefits page.  A Maternity Module will now be available for this member in the Payer Spaces section of Availity.

If you would like more information about the New Baby, New Life program or have a patient who would benefit from case management, please call Provider Services:

Case Management Provider Services:


Los Angeles County

1-888-285-7801

All Other California Counties

1-800-407-4567

Pregnant Patients: Steps to take for PCPs and Obstetricians

  • Notify Anthem of a patient’s pregnancy via ICR or via fax. If sending via fax, see the Forms section below for the Notification of Pregnancy Form. Fax the completed form to Anthem Blue Cross at 1-833-410-4451
  • Complete the Maternity Module in Availity.
  • California Health and Safety Code Section 125107 requires prenatal care providers to offer HIV counseling and testing to pregnant women. Per the law, this requires documentation that patients were offered HIV counseling, testing and information.
  • Providers should refer all pregnant and breastfeeding members enrolled in Medi-Cal Managed Care (Medi-Cal) to the California Supplemental Nutrition Program for Women, Infants, and Children (WIC) in their area. This program serves low-income pregnant, breastfeeding, and postpartum women and their infants who are at nutritional risk. Referral forms can be requested from local WIC agencies or by calling the State WIC Branch at 1-888-942-9675.
  • If the patient’s pregnancy becomes high-risk at any time during prenatal care, please notify Anthem by fax using the Case Management Referral Form.

Breastfeeding

  • Pregnant members should be referred to Anthem’s Health Education department prior to delivery for assistance connecting to breastfeeding resources. Please email healthed_ca_medicaid@anthem.com for assistance.
  • If you would like more information about breastfeeding or prenatal education, please call Provider Services and ask for the Prenatal Project Coordinator:
    • 1-888-285-7801 in Los Angeles County
    • 1-800-407-4627 in all other California counties
  • If a patient has general questions about lactation or breastfeeding, please refer them to the 24/7 NurseLine at 1-800-224-0336. A registered nurse is available 24/7 to answer questions.
  • If the mother is unable to breastfeed due to medical reasons and the infant cannot tolerate or has medical contraindications to the use of any formula, including elemental formula, you must arrange for the provision of human milk for the newborn. Contact the Mothers’ Milk Bank of Santa Clara Valley at 1-877-375-6645. If you have questions regarding insurance coverage for donor breast milk, please fill out the donor breast milk inquiry form on mothersmilk.org.
 
 

Breast Pumps and Devices

Lactation management aids are covered by Anthem for Medi-Cal members. Three lactation aid devices are available:

  • Hand-held breast pumps (nonelectric) can be obtained via prescription without prior authorization.
  • Nonhospital-grade (single user) pumps (AC and/or DC) are only provided if medically necessary. Review clinical UM Guidelines CG-DME-35 for more information.
  • Hospital-grade pump rentals (AC and/or DC) are only provided if medically necessary. Review clinical UM Guidelines CG-DME-35 for more information.

For instructions on how to place an order for a breast pump, please see the Breastfeeding Support PDF.

Substance Use Disorders in Pregnancy and Neonatal Abstinence Syndrome

Substance use disorders (SUDs) are on the rise and are of particular concern in women of childbearing age who are or may become pregnant. OB providers have a unique opportunity to help break the pattern of opioid misuse, thus avoiding health consequences for both mother and child. The important steps in this practice are to identify, treat, and/or refer to treatment women who are using/abusing unhealthy substances. Anthem is here to support providers, pregnant members and their little ones on the way. 

If you would like more information about the OB Case Management program or have a patient who would benefit from case management, call Provider Services:

  • 1-888-285-7801 in Los Angeles County
  • 1-800-407-4627 in all other California counties

Forms

To view and access forms related to pregnancy and maternal child services, please visit the Forms page.

Provider tools & resources

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We look forward to working with you to provide quality services to our members.