Find Care No Suggestions found Individual & Family Medicare Medicaid Employers Producers Providers COVID-19 Info Log In Main Content Information for Maine Change State Policies, Guidelines & Manuals We’re 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, practice policies, the provider manual and support for delivering benefits to our members. Medical Policies & Clinical UM Guidelines Medical policies address the medical need for new services or procedures and new applications of existing services or procedures. Clinical utilization management (UM) guidelines focus on selection criteria, length of stay, and location for generally accepted technologies or services. View Medical Policies & Clinical UM Guidelines Provider Manual Anthem's Provider Manual provides information about key administrative areas, including policies, programs, quality standards and appeals. Download the Manual Reimbursement Policies Our reimbursement policies are available to promote a better understanding of the claims editing logic that may impact payment. Access policies Clinical Practice Guidelines This index compiles guidelines published by third-parties and recognized by Anthem for the diagnosis and treatment of specific clinical circumstances. Download the index More Resources Preventive Health Guidelines We publish guidelines for routine health measures that can help prevent 85% of illness and disease. Members can access this information at any time by using our online self-service tool. Review the guidelines Member Rights and Responsibilities When it comes to their health care, members have certain rights and responsibilities. Learn about these to help your patients take an active role in their care. Read about member rights Transparency Statement From time to time, as permitted by contractual or regulatory obligations, Anthem contracts with an outside entity to provide our members or providers with various services—such as Utilization Management or Case Management—on our behalf. In addition, we may use an entity outside of the United States to perform some select utilization management approvals. We have a common goal of helping to ensure that your patients receive access to quality, evidence-based, efficient care. If you have questions about this statement, please contact your local Provider Call Center. Ready to become a provider in the Anthem network? We look forward to working with you to provide quality service for our members. Begin Application About Privacy Legal Accessibility Nondiscrimination Notice Health Care Fraud Prevention Medicaid Producers Employers Federal Employees Press Room Careers Anthem Foundation Select a language Toggle Dropdown Use the App Let's make healthy happen Sydney Care is offered through an arrangement with CareMarket, Inc. Sydney Health and Sydney Care are service marks of CareMarket Inc., © 2021. © 2005 - 2021 copyright of Anthem Insurance Companies, Inc. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Feedback