Policies, guidelines and manuals

Wellpoint is committed to supporting you in providing quality care and services to our members. Here, you will find information for assessing treatment options, guidelines for clinical utilization management (UM), practice policies and support for delivering benefits to our members.

Provider manual

Wellpoint provider manuals provide key administrative information, including plan benefits, member eligibility, the quality improvement program, the UM program, credentialing and quality standards for participation, claims submission and appeals, and reimbursement and administration policies.

Documents

2023 Provider Digital Engagement Supplement

Claim Solution Resource Guide

Medicaid/CHIP Provider Manual

Medicaid/CHIP Provider Quick Reference Guide

Medicare Advantage Quick Reference Card

Medicare Provider Manual

Nursing Facility Provider Manual

Provider and facility digital guidelines

STAR+PLUS MMP (Medicare-Medicaid Plan) Provider Manual

Medical Policies and Clinical UM Guidelines

There are several factors that impact whether a service or procedure is covered under a member’s beneﬁt plan. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary.

Medical Policies and Clinical UM Guidelines