Transition to Carelon Medical Benefits Management, Inc. MRI Breast Clinical Appropriateness Guidelines

Effective September 10, 2023, Anthem Blue Cross and Blue Shield Medicaid will transition the Clinical Criteria for medical necessity review of MRI Breast to the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines:

• Oncologic imaging 
• Chest imaging

As part of this transition of Clinical Criteria, the following procedures will be subject to prior authorization at Carelon Medical Benefits Management*:

Note: This update does not apply to the Federal Employee Program^® (FEP^®)

As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon Medical Benefits Management via the ProviderPortalSM : 

• Access the Carelon Medical Benefits Management ProviderPortal_SM directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.

If you have questions related to clinical guidelines, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines at https://guidelines.carelonmedicalbenefitsmanagement.com/.