Policies, Guidelines and Manuals
Anthem Blue Cross and Blue Shield (Anthem) is committed to supporting you in providing quality care and services to the members in our network. The provider manual is your key source for member benefits, program requirements and other administrative guidelines. Our Utilization Management (UM) Guidelines, Medical Policies and Clinical Practice Guidelines offer additional guidance for providing care to our members.
Provider manual
Our provider manual is designed for contracted Anthem providers, hospitals and ancillary providers. Our goal is to create a useful reference guide for you and your office staff.
Clinical practice guidelines
Anthem’s Clinical Practice Guidelines follow nationally recognized best practices for standards of treatment and give providers a powerful tool in educating our members.
Medical policies and clinical UM guidelines
Medical Policies outline medical necessity requirements for certain services and procedures. Clinical UM Guidelines help guide coverage decisions involving precertification, inpatient review, level of care, discharge planning and retrospective review.
Related information
- August 2023 Clinical Utilization Management Guidelines
- HEDIS Coding Booklet 2024
- HEDIS ECDS Coding Booklet 2024
- HEDIS Desktop Reference Guide 2024
- Electronic Clinical Data Systems coding booklet
- August 2022 Clinical Utilization Management Guidelines
- HEDIS Category II Coding Bulletin 2023
- HEDIS Well Child and Immunizations Coding Bulletin 2023
- HEDIS ECDS Prenatal and Postpartum Care Coding Bulletin 2023
- HEDIS Coding Booklet 2023
- HEDIS Desktop Reference Guide 2023 WI
- Preventive Health Guidelines - English
- Preventive Health Guidelines - Spanish
- Centers of Medical Excellence Transplant Operations Manual
- February 2022 Clinical Utilization Management (UM) Guidelines
- February 2020 Clinical Utilization Management (UM) Guidelines
- May 2020 Clinical Utilization Management (UM) Guidelines
- August 2020 Clinical Utilization Management (UM) Guidelines
- November 2020 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- Provider Experience Quick Reference Guides
- November 2022 Clinical Utilization Management Guidelines
- Clinical Utilization Management Criteria February 2023
- Clinical Utilization Management Criteria May 2023
- Clinical Utilization Management Criteria November 2023
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn About Availity
- Precertification Lookup Tool
- Precertification Requirements
- Claims Overview
- Member Eligibility & Benefits Overview
- Policies, Guidelines & Manuals
- Referrals
- Forms
- Provider Training Academy
- Electronic Data Interchange (EDI)
Interested in becoming a provider in the Anthem network?
We look forward to working with you to provide quality services to our members.
©2021 copyright of Anthem Insurance Companies, Inc.
Anthem Blue Cross and Blue Shield is the trade name of Compcare Health Services Insurance Corporation, an independent licensee of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. HEDIS ® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS ® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
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