The Medical Policies, Clinical Utilization Management (UM) Guidelines and Third Party Criteria below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed.


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Effective October 6, 2021,
Anthem Blue Cross and Blue Shield Medicaid (Anthem) will begin using the AIM Specialty Health®* Clinical Appropriateness Guidelines for medical necessity review of the below services. Please note, the Anthem Utilization Management team will complete these reviews using the AIM Clinical Appropriateness Guidelines.

  • Computed Tomography to Detect Coronary Artery Calcification will be reviewed using the AIM Imaging of the Heart Guideline



Featured In:
October 2021 Anthem Provider News - Kentucky