Provider manuals and guides
Anthem Blue Cross and Blue Shield (Anthem) is 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 (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.
Medical Policies and Clinical UM guidelines
Anthem uses nationally recognized, evidence-based Medical Policies and Clinical UM Guidelines.
Anthem licenses and utilizes MCG Care Guidelines to guide utilization management decisions for some health plans. This may include but is not limited to decisions involving prior authorization, inpatient review, level of care, discharge planning and retrospective review. MCG Care Guidelines licensed include:
- Inpatient and Surgical Care (ISC)
- General Recovery Care (GRG)
- Ambulatory Care (AC)
- Recovery Facility Care (RFC)
- Home Care (HC)
- Behavioral Health Care (BHG)
- Chronic Care Guidelines (CCG)
MCG and Anthem’s Medical Policies and Clinical UM Guidelines are available and can be requested by contacting Provider Services at 844-912-1226 or by emailing Anthem at ohiomedicaidprovider@anthem.com .
Medicaid managed care requirements in the Ohio Administrative Code and Ohio Revised Code
Clinical practice guidelines
- Preventive health guidelines - Coming Soon
Provider tools & resources
- Log in to Availity Essentials
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Provider Search Tool
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)