Effective with dates of service on and after February 1, 2019, Anthem will adopt the clinical guideline Neonatal Levels of Care (CG-MED-26) to expand the pre-authorization review of neonatal intensive care unit (NICU) cases to include level of care review for members.


This guideline addresses the level of care review for NICU admissions. The medical necessity criteria is based on peer reviewed literature and evidence based practice guidelines.


Please note, this program does not apply to the National Accounts, Medicaid and Medicare plans.

For questions, please contact the provider service number on the back of the member ID card.

Featured In:
November 2018 Anthem Ohio Network eUpdate