Anthem Blue Cross Blue Shield Health Insurance

Overview

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Anthem Medical Policies & Clinical UM Guidelines 
Welcome to Anthem’s Medical Policy & Clinical UM Guideline website. Our goal in creating this application is to provide you with ready access to electronic versions of medical policies and clinical UM guidelines. 
 
Finding Medical Policies & Clinical UM Guidelines
Anthem medical policies are listed by the following categories under the tabs noted above: 
All Medical Policies
Policies by Type
 
Anthem Clinical UM Guidelines are listed by the following categories under the tabs noted above: 
All UM Guidelines
Guidelines by Type
 
You can locate a medical policy or clinical UM guideline by clicking on a category, or by browsing all medical policies or all clinical UM guidelines, or by using the search function. 
 
Search for Medical Policies & Clinical UM Guidelines
 
Customizations to Milliman Care Guidelines®  
This document provides a high level summary of customizations to the Milliman Care Guidelines® 14th Edition 
 
Contact Us  
The following contact us e-mail address is for questions related to the research and development of medical policies and clinical Utilization Management (UM) guidelines found on this site. For those inquiries you may contact us at: Medical.Policy@WellPoint.com  
Please direct inquiries related to benefit coverage, new ID cards, billing practices, prior authorization, pre-determination or reimbursement and any other inquiries unrelated to medical policy or clinical guidelines to the local plan provider representative, billing/reimbursement department or Customer Service, as applicable, by calling the number listed on the member ID card. We will not be able to respond to those inquiries. 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross Blue Shield Association. ® ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Serving residents and businesses in Indiana, Kentucky, Missouri (excluding 30 counties in the Kansas City area), Ohio, Wisconsin, Colorado, Nevada, Connecticut, Maine, New Hampshire and Virginia (excluding the city of Fairfax, the town of Vienna and the area east of State Route 123). Use of the Anthem Web sites constitutes your agreement with our Terms of Use