Policy Updates Medical Policy & Clinical GuidelinesMedicaidNovember 22, 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 HealthPlus:

  • Musculoskeletal Guidelines:
    • Small Joint Surgery 

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, contact your assigned provider relationship management representative or call Provider Services at 800-450-8753.

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

Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross Blue Shield Association.

NYBCBS-CD-037850-23-CPN37060

PUBLICATIONS: December 2023 Provider Newsletter