Anthem Blue Cross of California
Primary Care Physician assignment for California Individual plans
January 9, 2017
As you know, for the 2017 benefit year, part of our contractual mandated requirements with CoveredCA, Anthem Blue Cross is required to assign all PPO/EPO members to a Primary Care Physician (PCP).
Anthem will be assigning PCPs to enrolled ON and OFF Exchange members unless a valid PCP selection has already been made. Please note that grandfathered plan members will NOT be affected.
This mandate from Covered California is designed to support improved health by promoting the establishment of a Physician/Patient relationship for all those enrolled with PPO or EPO benefits.
Key Points
- PPO/EPO PCPs are not gatekeepers – PPO/EPO members do not need prior authorization for referrals or specialty care. PPO/EPO members may choose to establish a relationship with their assigned doctor but are under no obligation to do so.
- Anthem will be using a Member Preferred Physician (MPP ID) as the code for the PCP designation.
- PPO/EPO PCP information will NOT be included on ID cards. Members will be notified of their assignment by letter starting in February.
- PPO/EPO members can select their PCP by logging into the member site at anthem.com/ca, selecting the Profile tab and “Primary Care Physician.”
This article applies to:
- California
- Individual (under 65)