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.

Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual

Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Provider Manual

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.

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.

Clinical Practice Guidelines

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Provider Manuals, Policies and Guidelines