Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsDecember 28, 2023

Transition to Carelon Medical Benefits Management, Inc. cardiology guidelines

Effective April 1, 2024, requested cardiology interventions will be transitioned to the following Carelon Medical Benefits Management, Inc. guidelines for medical necessity/clinical appropriateness reviews. Applicable CPT® codes lists are included in each guideline linked below:

Preapproval requirements remain the same. The requested services received on or after April 1, 2024, will be reviewed with the new Clinical Criteria.

As a reminder, ordering and servicing care providers may submit preapproval requests to Carelon Medical Benefits Management using the ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.

For questions related to guidelines, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

We are focused on reducing administrative burdens, so you can do what you do best — care for our members.

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

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-042159-23-CPN41724

PUBLICATIONS: January 2024 Provider Newsletter