Primary Care

Primary care provider roles and responsibilities

The PCP’s role is to provide members with a medical home, the member’s first stop in the health care process and a centralized hub for a wide variety of ongoing health care needs. 

The PCP’s role is to:

  • Complete an Initial Health Appointment within 120 days of enrollment.
  • Help members schedule appointments with other providers and health education programs.
  • Track and document appointments, clinical findings, treatment plans and care received by members referred to specialists or other health care providers to ensure continuity of care.
  • Screen and evaluate procedures for detection and treatment of or referral for any known or suspected behavioral health problems and disorders.
  • Refer members to specialists or specialty care, behavioral health services, health education classes and community resource agencies, when appropriate.
  • Coordinate with the Woman, Infants and Children (WIC) program to provide medical information necessary for WIC eligibility determinations such as height, weight, hematocrit or hemoglobin.
  • Coordinate with the local tuberculosis (TB) control program to ensure that all members with confirmed or suspected TB have a contact investigation and receive Directly Observed Therapy (DOT).
  • Refer members to specialists or specialty care, behavioral health services, health education classes and community resource agencies including the California Department of Developmental Services regional centers, which are responsible for the Early Start Program (ESP) for children up to 3 years of age with developmental disabilities. Community resources also include the Child Health and Disability Prevention Program (CHDP), and California Children's Services (CCS).

Continuity of care

Anthem Blue Cross (Anthem) will work with PCPs and medical groups (when applicable) to facilitate the continuity of care/transition of care (COC/TOC) when members need assistance in transitioning to in-network providers or facilities. The goal of this process is to minimize service interruption and to assist in coordinating a safe transition of care.

This also applies to dually eligible members (Medicare and Medi-Cal) and members who are transitioning from Medi-Cal Fee-For-Service (FFS) to enrolled members of Medi-Cal Managed Care (Medi-Cal). For more guidance on members’ rights to continuity of care, please use our resources and information available through the Department of Health Care Services (DHCS).

Continuity of Care resources

Continuity of Care DHCS Guidance
DHCS Continuity of Care for Medi-Cal Managed Care Members

How to verify a member has designated you as their primary care provider

Members enrolled in Anthem Blue Cross (Anthem) may select any contracted PCP as their primary physician as long as that PCP is taking new patients. We furnish each PCP with a current list of assigned members and from time to time provide medical information about our members’ potential health care needs. In this way, providers can more effectively provide care and coordinate services.

Providers can verify that a member is assigned to them any time via Availity. Log in to the Provider Online Reporting tool to view the monthly PCP rosters. For other ways to get in touch regarding PCP verification, please refer to your provider manual or visit the Contact Us page.

Tobacco Cessation Requirements for Medi-Cal providers

Anthem is responsible for ensuring PCPs and their qualified staff implement the interventions outlined in MMCD Policy Letter 16-014 . This includes identifying all members, initially and annually, of any age who use tobacco products or are exposed to tobacco smoke and document this information in the member’s medical record. This can be accomplished by using the SHA or an equivalent, approved assessment. Providers must ask tobacco users about their tobacco status at every visit and document their responses in their medical record.
Health education classes
Health education classes are available at no charge to Anthem Blue Cross (Anthem) members enrolled in Medi-Cal Managed Care (Medi-Cal) and are accessible upon self-referral or referral by Anthem network providers. Typically, these classes take place with our hospital and community organization partners.
Class availability varies by County. Topics include:
  • Asthma management.
  • Childbirth/Lamaze/Prenatal education.
  • Diabetes management.
  • Injury prevention.
  • Nutrition.
  • Parenting/well child.
  • Smoking cessation/tobacco prevention.
  • Substance abuse.
To refer a member to a health education class, please use the findhelp social care network to search and connect members to health education support, financial assistance, food pantries, and other free help.
 
 
Additional resources:
 
In addition, Anthem has an extensive selection of health education materials, in both English and Spanish, available at Health Education Resources under the Get Help section to find useful Apps and downloadable health information. Providers may contact healthed_ca_medicaid@anthem.com to request education materials for members.
 
These materials may be translated into additional languages upon request. They are also available in alternative formats, including Braille, large print and audio by contacting the Customer Service number on the back of the member card or by contacting CACulturalLinguisticServicesInbox@elevanchealth.com. Translations and alternative formats are free of charge.
 

Related resources for PCPs

For information related to long-term services and supports (LTSS), interpreter assistance, community-based adult services (CBAS) and other programs, please visit the Provider Training Academy page.

Provider tools & resources

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

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