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[California] Independent FFS Physicians option — FAQ
Anthem BCBS·CA·Provider Bulletin
Effective date
Jul 29, 2026
We identified it
Jul 30, 2026
Summary
Anthem Blue Cross has formalized the Independent FFS Physicians option for California providers treating Pathway HMO members. Providers in this network bill HMO members using PPO fee-for-service rates and must follow specific authorization and referral requirements. Billing teams must implement new workflows for prior authorization submission (via fax only, not Availity), referral management, and member identification verification.
Action Required
IMMEDIATELY (effective July 29, 2026): 1) Billing team must update claim submission procedures to recognize Independent FFS Physicians Admin or Caremore Ind FFS Physicians Admin identifiers on member ID cards in upper right corner. 2) Implement mandatory prior authorization workflow for laboratory testing, radiology, and diagnostic imaging for Pathway HMO members—submit fax to 866-461-2401 with completed Referral and Prior Authorization Request Form; do NOT use Availity Essentials for preapproval requests. 3) Update referral process to require in-network Independent FFS Physicians specialists for all specialty care except behavioral health, urgent care, reproductive/sexual health, OB/GYN consultations, and other services listed in member's Evidence of Coverage. 4) Train billing staff that referral status can be checked via Availity Essentials (Authorization & Referrals Dashboard), but submission must be by fax only. 5) Ensure all claims include authorization numbers when required to prevent denials. 6) Providers must opt-in or opt-out by emailing specialnetwork req@anthem.com with subject 'Independent FFS Physicians' and tax ID if declining participation. Failure to obtain required prior authorizations will result in claim denials.