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
Medicaid/CHIP Provider Quick Reference Guide
Medicare Advantage Quick Reference Card
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
Documents
2024 Clinical Practice Guidelines
May 2021 Clinical Utilization Management (UM) Guidelines
August 2021 Clinical Utilization Management (UM) Guidelines
November 2021 Clinical Utilization Management (UM) Guidelines
February 2022 Clinical Utilization Management (UM) Guidelines
August 2022 Clinical Utilization Management Guidelines
November 2022 Clinical Utilization Management Guidelines
Clinical Utilization Management Criteria February 2023
Clinical Utilization Management Criteria May 2023
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We look forward to working with you to provide quality service for our members.