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Health Management


Health Management and Coordination
Anyone living with chronic disease or an acute health condition does not need additional complications or unanswered questions. If you are, we’ll work with you, your doctor and other health care providers to help you get the care and support you need.  
Please check your member booklet or ask your group administrator if you have coverage for all of the following services
Comprehensive Medical Management

Utilization Review

Our Utilization Review program prior authorizes hospital admissions and certain treatments and procedures. This is to give you access to high-quality health care services. Our Utilization Review team is made up of dedicated nurse care managers and medical directors.

Concurrent Review

During your hospital stay, a case manager works directly with your doctor and the hospital to make sure you get the care you need.

Discharge Planning and Follow-Up

A case manager works with your health care team throughout your hospital stay. A discharge plan is made with you, your family, your doctor, the hospital and other health care providers to make sure the best plan is made so you have a smooth transition home or to another facility.

Total Joint Replacement Program

Get the information and services you need to focus on preparing for and recovering from surgery. The program teams you, your family and doctor with a nurse care manager who can answer health and benefits questions and coordinate your care during recovery.


If you or a family member suffer from a chronic condition like asthma, diabetes, coronary artery disease, heart failure, chronic obstructive pulmonary disease or kidney disease, this voluntary program can help you achieve your personal health goals and manage your health. Dedicated nurse care managers work with you, as well as your doctors, to help you carry out your doctors’ individual plan of care. To speak with a ConditionCare nurse, call 1-866-596-9812.

Radiation Utilization Management

Advanced imaging tools like CT scans and MRIs can really help identify underlying health problems. But the American College of Radiology estimates that 20-30 percent of these tests are not medically necessary or are duplicative.1 Unnecessary imaging may contribute to two patient safety issues: increased radiation exposure and false positive findings that may result in additional testing and potential surgical procedures. To help make sure you receive services that are safe and appropriate, we work with your doctors to determine if the imaging recommended is an appropriate choice for diagnosing the problem at hand.

Transplant Program

We belong to the Blue Distinction Transplant Center network to help you access the highest level of care available. Blue Distinction Transplant Centers are designated facilities that meet stringent quality criteria, as established by national organizations and expert clinician panels.


If you’ve got multiple health care issues and are at risk for needing frequent and high levels of medical care, this program may be for you. Our goal is to help you access quality care, learn to effectively manage your conditions and lead the healthiest life possible. You get a nurse care manager who works closely with you and your doctor to:

Create an individualized care plan

Develop personalized goals

Coordinate care

Neonatal Intensive Care Program

If your newborn is in the neonatal intensive care unit, this program can help. A specialized team of nurse care managers and medical directors work with you, your family and doctors to make sure your baby receives the best care possible.

©2005-2015 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, 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 (excluding 30 counties in the Kansas City area): 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. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use