Pregnancy and Maternal Child Services

When it comes to pregnancy, we are committed to healthy outcomes for our members and their babies.

New Baby, New LifeSM

New Baby, New LifeSM is a proactive care management program for all expectant members and their newborns. Once pregnant members are identified, we act promptly to assess obstetrical risk and ensure the provision of appropriate care management services to mitigate risk.

Experienced care managers collaborate with members and providers to develop a personalized care plan for our highest-risk pregnant members. They may also collaborate with community partners to facilitate connecting members to local and national agencies that can assist with services and support.

When it comes to pregnancy, we are committed to healthy outcomes for our members and their babies. That is why we encourage all of our pregnant and postpartum members to take part in our New Baby, New Life program, a comprehensive program which offers:

  • Individualized, one-on-one complex care management support for members with the highest risk
  • Care coordination for those members who need a little extra support
  • Digital perinatal educational tools
  • Information on community resource
  • Incentives to encourage members to keep up with checkups

As part of the New Baby, New Life program, perinatal members have access to a digital perinatal offering. This digital offering is available through a smartphone app and provides pregnant and postpartum members with timely, proactive, and culturally sensitive education. Once members are identified as being pregnant, they will receive an invitation to access this program by downloading the app. After the app is installed and the member registers, they are asked to complete a pregnancy screener. The answers provided in the screener allow us to assess their pregnancy risk.

After the risk assessment has been completed, the app delivers gestational age-appropriate education directly to the member. This digital offering does not replace our high-touch, individualized care management approach for our highest-risk pregnant members; however, it serves as a supplemental tool to extend our health education outreach. The goal of the expanded outreach is to ensure maternity education is available to all perinatal members and help Anthem to identify members who experience a change in risk acuity throughout the perinatal period.

We encourage healthcare providers to share information about this program and the digital perinatal app offered to members. Members may access information about the products that are available by visiting our member website .

For more information about the New Baby, New Life program or the digital app, please contact our Medi-Cal Customer Care Center at 800-407-4627 (TTY 711) outside L.A. County or 888-285-7801 (TTY 711) inside L.A. County.

Provider Services: 

Care Management:

1-888-334-0870

Notification of pregnancy and delivery:

We request notification of pregnancy at the first prenatal visit and notification of delivery following birth. You may choose to complete the notification of pregnancy and delivery in Availity Essentials or by faxing the completed forms to Anthem at 855-410-4451. 

We also ask that providers complete the Maternity Application in Availity Essentials during the initial Eligibility and Benefits (E&B) request performed on a pregnant member. The information obtained during this process supports our effort to identify pregnancies as early as possible so that we may notify eligible members of various perinatal resources, including the care management program.

The steps to complete the Maternity Application are:

  • 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
  • If the appropriate conditions apply for payer, user, member, and service type, the maternity question screen will display. Conditions include:
    • Member is female
    • Member is 45 years of age or under
    • Member 15 years of age or over
  • If member is not pregnant, select No and submit to continue to the E&B response screen
  • If member is pregnant, select Yes and submit. You will be prompted to enter additional dates if known:
    • Estimated Due Date
    • First Prenatal Appointment Date
  • When Yes is selected, the maternity data entered is saved for this member
  • After submitting your answer, the E&B response screen will display

Additional steps for perinatal providers:

  • 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.
  • Since 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.
  • Care providers should refer all pregnant and breastfeeding members enrolled in Medi-Cal Managed Care 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 member’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 member 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 member 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 questionnaire on the  Mother's Milk website .
 
 

Breast Pumps and devices

Our members cover lactation management aids. Three lactation aid devices are available:

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

For more information on how to place an order for a breast pump, please call provider services.

Forms

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

Provider tools & resources

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