Policy Updates Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageJanuary 1, 2024

Change to Prior Authorization Requirements

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

This communication applies to Commercial and Medicare Advantage plans from Anthem Blue Cross and Blue Shield.

Effective for dates of service on and after April 14, 2024, the following updates will apply to the Carelon Medical Benefits Management, Inc.  Clinical Appropriateness Guidelines.  As part of the Carelon Medical Benefits Management guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable health care services.

Refer to attachment to view full details.

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, and Hoosier Care Connect 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.

MULTI-BCBS-CRCM-043720-23-CPN42002

ATTACHMENTS: Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines (pdf - 0.11mb)

PUBLICATIONS: January 2024 Provider Newsletter