Policy Updates Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 28, 2023

Transition to Carelon Medical Benefits Management, Inc. cardiology guidelines

Effective April 1, 2024, Anthem will transition to the following Carelon Medical Benefits Management, Inc. guidelines to perform medical necessity/clinical appropriateness reviews for requested cardiology interventions. Applicable CPT® codes lists are included in each guideline linked below:

Preapproval requirements remain the same. The requested services received on or after April 1, 2024, will be reviewed with the new Clinical Criteria.

As a reminder, ordering and servicing care providers may submit preapproval requests to Carelon Medical Benefits Management using the ProviderPortalSM 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.

For questions related to 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 here.

We are focused on reducing administrative burdens, so you can do what you do best – care for our members.

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CRCM-042161-23-CPN41724

PUBLICATIONS: January 2024 Provider Newsletter