Provider policies, guidelines & manuals
Wellpoint is committed to supporting you in providing quality care and services to the members in our network. Here you will find information for assessing coverage options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to our members.
Provider manual and quick reference cards
The Wellpoint provider manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.
Provider Digital Engagement Supplement
Medical policies and clinical UM guidelines
Medical policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
Medical policies and clinical UM guidelines
May 2024 Clinical Utilization Management Guidelines
February 2024 Clinical Utilization Management Criteria
November 2023 Clinical Utilization Management Criteria
August 2023 Clinical Utilization Management Guidelines
Clinical Practice Guidelines Matrix
Clinical Utilization Management Criteria February 2023
November 2022 Clinical Utilization Management Guidelines
August 2022 Clinical Utilization Management Guidelines
February 2022 Clinical Utilization Management (UM) Guidelines
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We look forward to working with you to provide quality service for our members.