Policies, guidelines and manuals
Access information for assessing coverage options, medical policies, and more.
Provide quality care to our enrollees
Wellpoint District of Columbia, Inc. is committed to supporting you in providing quality care and services to the enrollees 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 enrollees.
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
Wellpoint District of Columbia, Inc. Clinical Criteria
November 2022 Clinical Utilization Management Guidelines
February 2023 Clinical Utilization Management Guidelines
May 2023 Clinical Utilization Management Guidelines
August 2023 Clinical Utilization Management Guidelines
November 2023 Clinical Utilization Management Criteria
February 2024 Clinical Utilization Management Criteria
May 2024 Clinical Utilization Management Guidelines
August 2024 Clinical Utilization Management Guidelines
Related information
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We look forward to working with you to provide quality service for our enrollees.