Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsDecember 4, 2023

Carelon Medical Benefits Management, Inc. updates — November 2023

The Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines below have been updated.

Effective for dates of service on and after November 5, 2023, the following updates apply to the Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity review for HealthKeepers, Inc.:

  • Musculoskeletal Guidelines:
    • Joint Surgery
    • Small Joint Surgery
    • MSK Level of care

Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff. If you have questions about this communication, contact Provider Services at 800-901-0020.

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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-037852-23-CPN37060

PUBLICATIONS: January 2024 Provider Newsletter