Policy UpdatesMedicare AdvantageMay 29, 2024

Carelon Medical Benefits Management, Inc. updates

This article was updated as of August 23, 2024.

Effective September 1, 2024, Anthem will transition to the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity/clinical appropriateness reviews for requested interventions. This article is to communicate the plan adoption of these Carelon Medical Benefits Management, Inc. guidelines. This does not equate to the presence of a prior authorization requirement. In the event a prior authorization requirement for these services will be implemented, a separate notice will be distributed before the addition of any prior authorization requirements.

  • Site of Care Guidelines:
    • Site of Care for Advanced Imaging
    • Rehabilitative Site of Care
    • Surgical Site of Care

Please share this notice with other members of your practice and office staff.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CTBCBS-CR-055357-24-CPN54514, MULTI-ALL-CDCR-066460-24

PUBLICATIONS: July 2024 Provider Newsletter