Policy Updates Reimbursement PoliciesMedicaid Managed CareMay 1, 2024

New lab testing Clinical Guidelines

Anthem is adopting new Clinical Utilization Management (UM) Guidelines for the lab testing listed below.

The guidelines state that only medically necessary lab testing will be covered. Effective July 1, 2024, coverage for these lab tests will be denied unless medical necessity is supported by the appropriate diagnosis code(s) found in the policies.

Clinical UM Guideline number and title:

Get answers to your questions about eligibility, benefits, authorizations, claims status, and more with Availity Essentials. Visit Availity.com and select the appropriate payer space tile from the drop-down. Then select Chat with Payer and complete the pre-chat form to start your chat.

For additional support, visit the Contact Us section at providers.anthem.com/oh for the appropriate contact.

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PUBLICATIONS: May 2024 Provider Newsletter