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. 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.

Anthem Blue Cross (Anthem) encourages notification of pregnancy after the first prenatal visit.

You may choose to complete the notifications of pregnancy and delivery in the online Interactive Care Reviewer (ICR) or via fax to 855-410-4451.

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

  • Perform an Eligibility and Benefits (E&B) request on the desired member
  • Choose one of the following benefit service types: maternity, obstetrical, gynecological, or obstetrical/gynecological
  • Before the benefit results screen, you will be asked if the member is pregnant. Choose Yes, if applicable. If you indicate Yes, you may provide the estimated due date, if it is known, or leave it blank if the due date is unknown
  • After submitting your answer, the E&B will display. If the member was identified as pregnant, a Maternity Form will now be available
  • You may access the form by navigating to the Applications tab and selecting the Maternity link

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:

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 855-410-4451
  • 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
  • As of July 1, 2019, obstetric providers are required to screen or offer to screen women for perinatal mood disorders. The American College of Obstetricians and Gynecologists has outlined depression screening instruments to be used during the pregnancy and postpartum periods including: The Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ). Providers are asked to document screening in the medical record.
  • 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 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

  • 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. Obstetric (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:

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.