Medical policies and clinical guidelines moving to pre-cert

The following Anthem Blue Cross and Blue Shield (Anthem) Medical Polices and Clinical Utilization Management Guidelines were reviewed on July 31, 2023, for Indiana, Kentucky, Missouri, Ohio, and Wisconsin.

To view Medical Policies and Clinical Utilization Management Guidelines, go to anthem.com > select Providers > select your state > under Provider Resources > select Policies, Guidelines & Manuals.

To help determine if prior authorization is needed for Anthem members, go to anthem.com > select Providers > select your state > under Claims > select Prior Authorization. You can also call the prior authorization phone number on the back of the member’s ID card. 

To view Medical Polices and Clinical Utilization Management Guidelines applicable to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan (commonly referred to as the Federal Employee Program^® FEP^®), please visit fepblue.org > Policies & Guidelines.

Below are the new Medical Policies and/or Clinical Utilization Management Guidelines that have been approved.

* Denotes prior authorization required.