Policy Updates Medical Policy & Clinical GuidelinesMedicaidNovember 7, 2023

Carelon Medical Benefits Management, Inc. updates

Effective April 1, 2024, Anthem Blue Cross will transition to the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity/clinical appropriateness reviews for requested interventions:

  • Cardiology Guidelines:
    • Cardiac Resynchronization Therapy
    • Endovascular Revascularization
    • Implantable Cardioverter Defibrillators
    • Permanent Implantable Pacemakers
  • Genetic Testing Guidelines:
    • Carrier Screening in the Prenatal Setting and Preimplantation Genetic Testing
    • Cell-free DNA Testing for the Management of Cancer
    • Chromosomal Microarray Analysis
    • Genetic Testing for Inherited Conditions
    • Hereditary Cancer Testing
    • Pharmacogenomic Testing
    • Polygenic Risk Scores
    • Prenatal Testing using cell-free DNA
    • Somatic Tumor Testing
    • Whole Exome Sequencing and Whole Genome Sequencing

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CD-041988-23-CPN41238

PUBLICATIONS: December 2023 Provider Newsletter