Provider manuals and guides
Wellpoint Washington, Inc. 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
Wellpoint provider Apple Health (Medicaid) manuals and Quick Reference Cards provide 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 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.
Related information
- Clinical Utilization Management Criteria May 2023
- Clinical Utilization Management Criteria February 2023
- 2023 Clinical Practice Guidelines Notification
- Site of Care Drug List
- November 2022 Clinical Utilization Management Guidelines
- August 2022 Clinical Utilization Management Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- February 2021 Clinical Utilization Management (UM) Guidelines
- 2024 Clinical Practice Guidelines
- Developmental screening, assessment and referral – last updated 8/21/17
- Integrated Managed Care SERI, National Provider ID (NPI) & Taxonomies
- SERI Billing Guide July 1, 2022
Provider tools & resources
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