Policy Updates Medical Policy & Clinical GuidelinesMedicaidJanuary 5, 2024

Carelon Medical Benefits Management, Inc. updates — November 2023

Effective for dates of service on and after November 5, 2023, the following updates will apply to the Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity review for Anthem:

  • Musculoskeletal Guidelines:
    • Joint Surgery
    • Small Joint Surgery
    • MSK Level of care

Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff. If you have questions about this communication or need assistance with any other item, call Provider Services at 844-396-2330.

With your help, we can continually build towards a future of shared success.

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CD-037849-23-CPN37060

PUBLICATIONS: February 2024 Provider Newsletter