The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed 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. For markets with carved-out pharmacy services, the applicable listings below are informational only.


Note: Effective July 30, 2018, InterQual® 2018 and 2018.1 releases will be used for inpatient and outpatient reviews.


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Medical Policies updates: May 2018

On May 3, 2018, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Anthem Blue Cross and Blue Shield Medicaid (Anthem).

Clinical UM Guidelines updates: May 2018

On March 22, 2018, the MPTAC approved the following Clinical UM Guidelines applicable to

Anthem. This list represents the guidelines adopted by the medical operations committee for the Government Business Division on April 19, 2018.

Featured In:
October 2018 Anthem Kentucky Provider Newsletter