Information for Providers

 

How to Enroll and Serve Path2Health Members

Anthem Blue Cross and its subcontractors, DentaQuest and Vision Service Plan (VSP), administer Path2Health benefits. They also administer CMSP benefits. If you are interested in providing health care services to Path2Health members, you must be a part of the Path2Health/CMSP provider network administered by Anthem Blue Cross (Anthem). To become a part of the network, you must execute a provider agreement. Participating providers are also encouraged to enroll in the Medi-Cal program as Medi-Cal providers, which will assist you in verifying Path2Health eligibility and any changes in eligibility, such as conversion to Medi-Cal or CMSP.

  • For further information about participating as a medical provider or a behavioral health services provider, contact Anthem Network Development at (800) 670-6133.
  • For further information about participating as a dental provider, contact DentaQuest Network Development at (800) 685-9971. DentaQuest serves as the dental benefits administrator for Path2Health and CMSP.
  • For further information about participating as a vision services provider, contact VSP Network Development at (800) 615-1883. VSP serves as the vision benefits administrator for Path2Health and CMSP.

How to Provide Medical, Dental and Vision Services

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 care 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 Medical, Dental and Vision Services

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. These same processes are used to bill for CMSP.

Dental providers are required to contract with DentaQuest to participate as a Path2Health dental provider. Billing for services in completed in accordance with DentaQuest rules. Providers can contact DentaQuest for further information at 800-341-8478,

Vision services providers are required to contract with VSP to participate as a Path2Health vision services providers. Billing for services in completed in accordance with VSP rules. Providers can contact VSP for further information at 800-615-1883,

Reimbursement Rates under Path2Health

Anthem administers Path2Health in accordance with payment rules and levels approved by the CMSP Governing Board under the Board's Rates of Payment Policy.  Rates of payment under Path2Health and CMSP are the same.

Benefit Coverage

Please see our listing for categories of Path2Health covered benefits and not covered benefits. Information concerning requirements and limitations is provided in the Path2Health POM.

Out of Network Emergency Services

Path2Health provides coverage for emergency hospital care provided by non-contracting providers in California, all other U.S. states, or all U.S. territories. Path2Health does not provide coverage for emergency care provided in other countries. Out-of-network emergency service providers are required to notify Anthem Blue Cross within 24 hours of admitting/registering the Path2Health member in a hospital emergency department. Post-stabilization services are also covered, subject to prior authorization and the determination of medical necessity.

Payment rates for out-of-network emergency services are set by the CMSP Governing Board in accordance with requirements contained in California law for Low Income Health Programs authorized by California law and State of California’s 1115 Medicaid Waiver.

Participating Counties

Thirty-five (35) counties participate in Path2Health. These counties also participate in CMSP. To receive Path2Health benefit coverage, the beneficiary must reside in one of the 35 counties.

Contact Information

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.

Member Questions/Referrals

For further information about Path2Health eligibility, applicants and enrollees are encouraged to contact their county eligibility worker. For information regarding covered benefits or assistance finding a provider, members may call the Anthem Customer Care Center (CCC) at (800) 670-6133.

 

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