Policy UpdatesMedicare AdvantageMay 29, 2024

Carelon Medical Benefits Management, Inc. updates

This article was updated as of September 6, 2024.

Effective September 1, 2024, the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guideline updates will be adopted for Anthem. This article is to communicate the plan adoption of these Carelon Medical Benefits Management, Inc. guidelines. This does not equate to the presence of a prior authorization requirement. In the event a prior authorization requirement for these services will be implemented, a separate notice will be distributed before the addition of any prior authorization requirements. 

To view a guideline, visit https://anthem.com/provider/policies. Additionally, you may access and download a copy of the current and upcoming guidelines here:

  • Site of Care Guidelines:
    • Site of Care for Advanced Imaging
    • Rehabilitative Site of Care
    • Surgical Site of Care

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

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-055356-24-CPN54514, WIBCBS-CR-064060-24, MULTI-ALL-CDCR-066460-24

PUBLICATIONS: July 2024 Provider Newsletter