Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageNovember 1, 2023

Carelon Medical Benefits Management, Inc. updates - November 2023

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

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 Empire BlueCross BlueShield:

  • Musculoskeletal Guidelines:
    • Small Joint Surgery

Existing precertification requirements have not changed. Share this notice with other members of your practice and office staff.

Through our efforts, we can help our care provider partners deliver high quality, equitable healthcare.

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

NYBCBS-CR-037771-23-CPN37065

PUBLICATIONS: November 2023 Provider Newsletter