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 .

Medicaid managed care requirements in the Ohio Administrative Code and Ohio Revised Code


Clinical practice guidelines

  • Preventive health guidelines - Coming Soon

Provider tools & resources

Join our network

We’re glad you’re interested in joining the Anthem network. We have a diverse network of exceptional healthcare professionals who ensure our members have uninterrupted access to the support they need.