Carelon Medical Benefits Management, Inc. updates

Effective April 1, 2024, Anthem Blue Cross and Blue Shield Healthcare Solutions will transition to the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity/clinical appropriateness reviews for requested interventions:

• Cardiology Guidelines:
  • Cardiac Resynchronization Therapy
  • Endovascular Revascularization
  • Implantable Cardioverter Defibrillators
  • Permanent Implantable Pacemakers
• Genetic Testing Guidelines:
  • Carrier Screening in the Prenatal Setting and Preimplantation Genetic Testing
  • Cell-free DNA Testing for the Management of Cancer
  • Chromosomal Microarray Analysis 
  • Genetic Testing for Inherited Conditions
  • Hereditary Cancer Testing
  • Pharmacogenomic Testing
  • Polygenic Risk Scores
  • Prenatal Testing using cell-free DNA
  • Somatic Tumor Testing
  • Whole Exome Sequencing and Whole Genome Sequencing