Policies, Guidelines and Manuals
HealthKeepers, Inc. is committed to supporting you in providing quality care and services to the members in our network. Find information on member benefits, program requirements, Utilization Management (UM) guidelines, clinical practice policies and other resources for providing care to our members.
Provider manual
The Anthem HealthKeepers Plus Provider Manual is your key source for information about covered benefits, case management and UM programs, claims and appeal guidance, authorization requests, and other program requirements.
Clinical practice guidelines
HealthKeepers, Inc. considers Clinical Practice Guidelines (CPGs) an important component of healthcare. We’ve adopted nationally recognized CPGs and encourage providers to use these guidelines to improve members’ health.
Medical policies and clinical UM guidelines
Medical Policies outline the medical necessity requirements of certain services or procedures, including new applications of these services. Clinical UM Guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
Related information
- May 2024 Clinical Utilization Management Guidelines
- February 2024 Clinical Utilization Management Guidelines
- November 2023 Clinical Utilization Management Guidelines
- August 2023 Clinical Utilization Management Guidelines
- HEDIS Coding Booklet 2024
- HEDIS ECDS Prenatal and Postpartum Coding Bulletin 2024
- HEDIS ECDS Coding Booklet 2024
- HEDIS Well Child and Immunization Coding Bulletin 2024
- HEDIS CAT II Coding Bulletin 2024
- HEDIS Desktop Reference Guide 2024
- Clinical Utilization Management Criteria May 2023
- Clinical Utilization Management Criteria February 2023
- November 2022 Clinical Utilization Management Guidelines
- HEDIS Benchmarks and Coding Guidelines for Quality Care
- Electronic Clinical Data Systems coding booklet
- August 2022 Clinical Utilization Management Guidelines
- HEDIS Category II Coding Bulletin 2023
- HEDIS Well Child and Immunizations Coding Bulletin 2023
- HEDIS Desktop Reference Guide 2023 VA
- HEDIS prenatal and postpartum care coding bulletin
- February 2022 Clinical Utilization Management (UM) Guidelines
- Long-term Services and Supports Authorization Guide
- Child Community Mental Health and Rehabilitation Services (CMHRS) UM Guideline
- Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Behavioral Therapy Program UM Guideline
- General Community Mental Health Rehabilitation Services (CMHRS) UM Guideline
- Virginia Medicaid Peer Support Services UM Guideline
- February 2020 Clinical Utilization Management (UM) Guidelines
- May 2020 Clinical Utilization Management (UM) Guidelines
- 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
- Member Eligibility & Pharmacy Overview
- Policies, Guidelines & Manuals
- Referrals
- Forms
- Provider Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)