Policies, guidelines and manuals
Find information for assessing coverage options, guidelines for Clinical Utilization Management (UM), practice policies and more.
Provider manual
Anthem’s provider manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.
Credentialing Program Summary Guide
Medical Policies and Clinical UM Guidelines
Medical policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
Access a complete list of the Medical Policies and Clinical UM Guidelines.
Clinical Utilization Management Criteria February 2023
Clinical Utilization Management Criteria May 2023
August 2023 Utilization Management Clinical Criteria
February 2024 Clinical Utilization Management Guidelines
May 2024 Clinical Utilization Management Guidelines
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Page last updated 10/17/2025