Anthem Blue Cross (Anthem) is committed to supporting you in providing quality care and services to the members in our network. Here you will find the Anthem provider manuals, guidelines for clinical Utilization Management (UM), medical policies and coding spotlights for common conditions.
The Anthem provider manuals provide key administrative information, details regarding programs that include the UM program and case management programs, quality standards for provider participation, guidelines for claims and appeals, and more.
We routinely update Medical Policies and Clinical UM Guidelines as part of the review process. Please visit Medical Policies & Clinical UM Guidelines: Full List on the Anthem website to view or search for specific 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.