Carelon Medical Benefits Management, Inc. updates

Effective on May 2, 2025, Anthem will transition to the following Carelon Medical Benefits Management Clinical Appropriateness Guidelines. This article is to communicate the plan adoption of these guidelines. Existing prior authorization requirements have not changed. In the event a prior authorization requirement for these services will be implemented, a separate notice will be distributed before the addition of any prior authorization requirements.

The following guidelines have a publish date of April 1, 2025:

• Cardiovascular:
• Ambulatory Cardiac Rhythm Monitoring
• Electrophysiological Studies
• Dialysis Access Evaluations
• Vascular Embolization and Occlusion Procedures

You may access and download a copy of the current and upcoming guidelines here.

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