Clinical Documentation Lookup Tool

A new way to review Medical Policies and Utilization Management (UM) Guidelines for needed documentation

Using Medical Policies and UM Guidelines, we’ve developed a tool that supplies you with a list of recommended documents when submitting prior authorizations or claims. The new Clinical Documentation Lookup Tool uses the CPT^® and HCPCS codes you enter to return real-time results.

Accessing the tool is easy, too — either by visiting our provider website (access the Clinical Documentation Lookup Tool from our Policies, Guidelines & Manuals section) or through Payer Spaces on Availity.com. For direct access, use this address (available mid-December) https://clinicaldocumentationtool.anthem.com/cdltui/home.

Start by entering in the member’s plan type, state, and service dates. Enter the Procedure Code or use the Keyword Search box. The recommended documents will be returned along with a full copy of the Medical Policy.

The Clinical Documentation Lookup Tool was developed to be intuitive and easy to use, but we’ve created a demonstration that points out some helpful tips. Access the demo from the top right navigation bar on the Clinical Documentation Lookup Tool.

The new Clinical Documentation Lookup Tool will be available in December. Try it and tell us what you think by completing the Was this tool helpful? question.

We are focused on reducing administrative burdens, so you can do what you do best — care for our members.