May 2021 medical policies and utilization management guidelines update

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.

 

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

To view a guideline, visit anthem.com/provider/policies/clinical-guidelines/search.

 

Updates

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

 

AKY-NU-0332-21