Provider manuals and guides
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 manuals and quick reference cards
The 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.
- HEDIS ECDS Prenatal and Postpartum Care Coding Bulletin 2024
- HEDIS Desktop Reference Guide for Medicaid Providers 2024
- Intermediate Care Facility for Individuals with Intellectual Disabilities Provider Quick Reference Guide
- 1915(c) Waiver Program Provider Quick Reference Guide
- Intellectual/Developmental Disabilities Managed Long Term Services and Supports Programs Provider Manual Supplement
- Medicare provider manual
- Medicaid provider manual
- Provider Manual Supplement TennCare CHOICES
- CHOICES Provider Quick Reference Guide
- Provider Quick Reference Guide
- CHOICES Provider Quick Reference Guide
- Community Living Supports (CLS) Provider Manual
Medical policies and clinical UM guidelines
Medical Policy addresses 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 Utilization Management Criteria May 2023
- Clinical Utilization Management Criteria February 2023
- November 2022 Clinical Utilization Management Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
- Adult Chiropractic Clinical Guideline for Tennessee
- 2023 Clinical Practice Guidelines
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Policies, guidelines & manuals
- Referrals
- Forms
- Training academy
- Pharmacy information
- Electronic data interchange (EDI)
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We look forward to working with you to provide quality services to our members.
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