Policies, Guidelines and Manuals

Anthem Blue Cross and Blue Shield (Anthem) is committed to supporting you in providing quality care and services to the members in our network. The provider manual is your key source for member benefits, program requirements and other administrative guidelines. Our Utilization Management (UM) Guidelines, Medical Policies and Clinical Practice Guidelines offer additional guidance for providing care to our members.

Provider manual

Our provider manual is designed for contracted Anthem providers, hospitals and ancillary providers. Our goal is to create a useful reference guide for you and your office staff.

Clinical practice guidelines

Anthem’s Clinical Practice Guidelines follow nationally recognized best practices for standards of treatment and give providers a powerful tool in educating our members.

Medical policies and clinical UM guidelines

Medical Policies outline medical necessity requirements for certain services and procedures. Clinical UM Guidelines help guide coverage decisions involving precertification, inpatient review, level of care, discharge planning and retrospective review.

Medical Policies and Clinical UM Guidelines

Provider tools & resources

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We look forward to working with you to provide quality services to our members.