Policy Updates Medical Policy & Clinical GuidelinesMedicaidDecember 4, 2023

Carelon Medical Benefits Management, Inc. updates — November 2023

The Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines below have been updated.

Effective for dates of service on and after November 5, 2023, the following updates apply to the Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity review for Anthem Blue Cross:

  • Musculoskeletal Guidelines:
    • Joint Surgery
    • Small Joint Surgery
    • MSK Level of care

Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff. If you have questions about this communication or need assistance with any other item, call one of our Medi-Cal Customer Care Centers at 800-407-4627 (outside L.A. County) or 888-285-7801 (inside L.A. County).

With your help, we can continually build towards a future of shared success.

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-037848-23-CPN37060

PUBLICATIONS: January 2024 Provider Newsletter