Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 10, 2024

Carelon Medical Benefits Management, Inc. updates

The Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines below have been updated. Existing precertification requirements have not changed.

Please share this notice with other members of your practice and office staff.

Effective for dates of service on and after April 14, 2024, the following updates will apply to the Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity review for the health plan:

  • Musculoskeletal Guidelines:
    • Interventional Pain Management
    • Sacroiliac Joint Fusion
  • Rehabilitation:
    • Physical, Occupational, and Speech Therapies

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-047283-23-CPN46505

PUBLICATIONS: February 2024 Provider Newsletter