Information for Providers
The Low Income Health Program, Path2Health, ended December 31, 2013. All Path2Health enrollees were transitioned to coverage under the Medi-Cal program on January 1, 2014.
For providers of health, dental and vision services to Path2Health enrollees for services provided on or before December 31, 2013, payment for services will be made in accordance with established payment rules.
Services for Path2Health beneficiaries are provided in accordance with the Anthem Provider Operations Manual (POM) for Path2Health, which is given to all providers participating in the network. The POM is also used for CMSP. Primary care services and most specialty services do not require pre-service review. Specified services, including ambulatory surgery, home infusion therapy, durable medical equipment and various other services require pre-service review from Anthem.
- How to Bill for Services Provided in 2013
- Reimbursement Rates
- Participating Counties
- Contact Information
Anthem Blue Cross and its subcontractors, DentaQuest and Vision Service Plan (VSP), administered Path2Health benefits. Contracting health care providers may bill Anthem or its subcontractors for services provided on or before December 31, 2013. Billing Anthem for medical and behavioral health services is done in accordance with billing rules described in the Anthem Provider Operations Manual (POM) for Path2Health. Hospitals and FQHC/RHC clinics use the UB-92 form. Medical groups, individual physicians and behavioral health providers utilize the CMS 1500 form.
Contracting dental providers are required to bill for services in accordance with DentaQuest rules. Providers can contact DentaQuest for further information at 800-341-8478,
Contracting vision service providers are required to bill for services in accordance with VSP rules. Providers can contact VSP for further information at 800-615-1883,
Anthem administered Path2Health in accordance with payment rules and levels approved by the CMSP Governing Board under the Board's Rates of Payment Policy.
Thirty-five (35) counties participated in Path2Health. To receive Path2Health benefit coverage, the beneficiary must have resided in one of the 35 counties.
Medical, dental and vision services providers can contact the Anthem Blue Cross, DentaQuest and VSP at the following numbers:
- Anthem Blue Cross Customer Care Center (CCC) at (800) 670-6133.
- DentaQuest Provider Services at (800) 341-8478.
- VSP Provider Services at (800) 615-1883.