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.
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
- 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
- Clinical Utilization Management Criteria May 2023
Provider tools and resources
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