Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsNovember 7, 2023

Carelon Medical Benefits Management, Inc. updates

Please note, this communication applies to Anthem HealthKeepers Plus Medicaid products offered by HealthKeepers, Inc.

Effective April 1, 2024, HealthKeepers, Inc. will transition to the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity/clinical appropriateness reviews for requested interventions:

  • Genetic Testing Guidelines:
    • Carrier Screening in the Prenatal Setting and Preimplantation Genetic Testing
    • Cell-free DNA Testing for the Management of Cancer
    • Chromosomal Microarray Analysis
    • Genetic Testing for Inherited Conditions
    • Hereditary Cancer Testing 
    • Pharmacogenomic Testing
    • Polygenic Risk Scores
    • Prenatal Testing using cell-free DNA
    • Somatic Tumor Testing
    • Whole Exome Sequencing and Whole Genome Sequencing

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800-901-0020.

HealthKeepers, Inc. is an independent licensee of the Blue Cross Blue Shield Association. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

VABCBS-CD-041991-23-CPN41238

PUBLICATIONS: December 2023 Provider Newsletter