Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective May 1, 2025, Anthem will upgrade to the 29th edition of non‑customized MCG Care Guidelines for the following modules. Below is high level summary of the updates and is not intended to be all inclusive:

  • Behavioral Health Care (BHG):
    • The guidelines for substance‑related disorders have been updated to allow users to identify ASAM citations more easily within MCG content. Benchmarks have been added to the guidelines for Applied Behavioral Analysis, Neuropsychological Testing, Psychological Testing, and Urine Toxicology Testing.
  • Inpatient & Surgical Care (ISC):
    • Five new observation care guidelines have been added. Also, a new mean arterial pressure (MAP) calculator has been added.
  • General Recovery Care (GRG):
    • A new Hospital‑at-Home General Recovery Guideline has been added.
  • Recovery Facility Care (RFC):
    • The discharge planning section for Inpatient Rehabilitation Facility guidelines was expanded.
  • Chronic Care (CCG):
    • New guidelines have been added to self‑management and low‑intensity disease management pediatric guidelines.
  • Ambulatory Care (AC):
    • A new Gene and Cellular Therapy section was introduced. A new Specialty Medication guideline has also been added. In addition, new guidance for supporting requests for APAP machines has been added.
  • Home Care (HC):
    • Updates to Clinical Indications for admission were made.
  • Multiple Condition Management (MCM):
    • New and updated Readmission Risk Assessments have been added.
  • Transitions of Care (TC)
  • Patient Information (PIP)

If you have questions, please contact Provider Services at 866‑408-6132 (Hoosier Healthwise), 844‑533-1995 (Healthy Indiana Plan), 844‑284-1798 (Hoosier Care Connect), or 833‑569-4739 (Indiana PathWays for Aging).

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

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-074793-24-CPN74542

PUBLICATIONS: March 2025 Provider Newsletter