Policies and Guidelines
We’re committed to supporting you in providing quality care and services to the members in our network. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies and support for delivering benefits to our members.
Medical Policies & Clinical UM Guidelines
Medical policy addresses the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical Utilization Management (UM) guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
UM Guidelines
Reimbursement Policies
Anthem has reimbursement policies for both facility providers and health care professionals.
Provider Manual
Anthem’s Provider Manual provides key administrative information, including the quality improvement program, the utilization management program, quality standards for participation, claims appeals, and reimbursement and administration policies.
