How to get contracted with Anthem Blue Cross Medi-Cal as a doula

1. 1

   Get approved in PAVE

   Anthem’s guide starts with Medi-Cal: doulas apply for enrollment directly with Medi-Cal through PAVE. Once DHCS approves you, you appear on the list of PAVE-approved doulas DHCS shares with Anthem, and you can contact Anthem to start contracting. See how to become a Medi-Cal doula.

2. 2

   Get a Type 2 NPI with the doula taxonomy

   Anthem’s contracting needs at least one organization-level (Type 2) NPI, and you bill at that NPI. Make sure its taxonomy list includes 374J00000X (Doula): Anthem uses taxonomy to process claims and to place you in its directory. Because Anthem assigns members partly by distance, it encourages doulas who serve several counties or locations to register more than one NPI.

   A Type 2 NPI belongs to an organization (an LLC, corporation or group), not to an individual. Many solo doulas form an LLC to get one.

3. 3

   Send the contracting documents

   Contact Anthem’s Doula Program (DHCS lists cadoulaprogram@anthem.com) to start. Anthem’s required contracting documents include, but aren’t limited to:

   • A scope of work.
   • Disclosure of ownership (DOO).
   • A W-9.
   • Proof of CPR certification from the American Heart Association or American Red Cross.
   • Proof of insurance: general, professional, workers’ compensation and commercial auto, “if applicable”. Ask which apply to you.
   • A background check attestation.
   • A roster of your doulas.

   Anthem notes contracting includes an organization-level administrative certification that’s separate from, and in addition to, the certification application.

4. 4

   Credential through CAQH

   Anthem asks the doulas on your roster to enroll in CAQH (the online credentialing portal many plans use) and submit their credentials there, including any subcontracted doulas. Keep CPR, HIPAA training and pathway documents current; the DHCS qualifications and three hours of continuing education every three years apply.

5. 5

   Know how Anthem referrals and recommendations work

   • Anthem internal referrals: the Doula Program team refers members to doulas directly.
   • Affiliated providers complete a written recommendation. Anthem prefers its Doula Services Benefit Recommendation Form; recommendations go to CADoulaServices@anthem.com.
   • Community partners may refer straight to you; if they do, tell the Doula Program team.
   • DHCS’s standing recommendation covers the standard package. Up to nine more postpartum visits (billed with Z1038) need a second recommendation on Anthem’s or DHCS’s form.

   Anthem also asks doulas to verify eligibility at every visit, preferably in Availity (payer “Anthem-CA”); Anthem Medi-Cal member IDs generally start with JQC or XDJ.

6. 6

   Submit claims through Availity

   • Electronic (preferred): through Availity Essentials. Anthem acknowledges electronic claims within 24 hours. In Availity you can check status, dispute, send corrected claims and attach records.
   • Paper: Claims and Billing, Anthem, P.O. Box 60007, Los Angeles, CA 90060-0007. Mark resubmissions “Corrected Claim” and attach the remittance advice.
   • Payments: enroll in electronic funds transfer through CAQH EnrollHub (844-815-9763).
   • Dual-eligible members in Anthem MediBlue Full Dual Advantage: bill with the Anthem-issued ID (for example MNL123W12345). Using the Medi-Cal or Medicare ID gets the claim rejected.
   • Anthem lists common reasons a claim doesn’t go through: member ineligibility, incorrect codes, illegible paper claims, and multiple services billed the same day.

   Anthem’s code table labels Z1034 “prenatal and postpartum visit” and Z1038 “additional postpartum visits”. The Medi-Cal Provider Manual uses Z1038 for postpartum visits generally. If you’re unsure which code Anthem wants for a postpartum visit within the first eight, ask the Doula Program team before billing. Our cheat sheet follows the Provider Manual.

This guide summarizes Anthem Blue Cross (Medi-Cal)’s published material for convenience and is not billing or legal advice. Plans change their processes and contacts; follow your contract and confirm with Anthem before you apply or bill.