Provider manuals and guides

Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) is committed to supporting you in providing quality care and services to the members in our network. On this page, you will find information for assessing coverage options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to our members.

Provider Manual

The Anthem 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.

Documents

• Prior authorization and notification requirements
• Provider Manual
• Provider Experience Quick Reference Guides
• Quick Reference Card

 

Medical Policies and Clinical UM Guidelines

Anthem uses nationally recognized, evidence-based Medical Policies and Clinical UM Guidelines.

Access a complete list of the Medical Policies and Clinical UM Guidelines.

Clinical Practice Guidelines

Documents

• ER auto-pay list
• February 2022 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
• Preventive Health Guidelines
• May 2020 Clinical Utilization Management (UM) Guidelines
• February 2020 Clinical Utilization Management (UM) Guidelines
• Clinical Practice Guidelines Matrix
• Q4 2017 Clinical Utilization Management (UM) Guidelines List