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
 

 Claim Solution Resource Guide
 

 Medicaid/CHIP Provider Manual

 

 Medicaid/CHIP Provider Quick Reference Guide

 

 Medicare Advantage Quick Reference Card

 

 Medicare Provider Manual

 

 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

 

 August 2023 Clinical Utilization Management Guidelines

 

 November 2023 Clinical Utilization Management Criteria

Interested in becoming a provider in the Wellpoint network?

 

We look forward to working with you to provide quality service for our members.

 

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