Provider Manuals, Policies and Guidelines
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.
Provider Manuals
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.
Clinical UM Guidelines
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.
- August 2022 Clinical Utilization Management Guidelines
- February 22 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- February 2021 Clinical Utilization Management (UM) Guidelines
- November 2020 Clinical Utilization Management (UM) Guidelines
- August 2020 Clinical Utilization Management (UM) Guidelines
- May 2020 Clinical Utilization Management (UM) Guidelines
- February 2020 Clinical Utilization Management (UM) Guidelines
- November 2019 Clinical Utilization Management (UM) Guidelines
Policies and 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.
Related Resources
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- Medical Records Documentation Standards
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- Provider Experience Quick Reference Guides
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
- Provider Manuals, Policies & Guidelines
- Referrals
- Forms
- Provider Training Academy
- Pharmacy Information
- Provider News & Announcements