Policy Updates Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageJanuary 1, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

This communication applies to Commercial and Medicare Advantage plans from Anthem Blue Cross and Blue Shield.

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.  As part of the Carelon Medical Benefits Management guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable health care services.

Refer to attachment to view full details.

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-CRCM-043720-23-CPN42002

ATTACHMENTS: Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines (pdf - 0.11mb)

PUBLICATIONS: January 2024 Provider Newsletter