Provider manuals and guides

Wellpoint 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 manual

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.

Guides and Documents

Wellpoint Medical Policies and Clinical UM Guidelines

Several factors 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. These guidelines are available to you as a reference when interpreting claim decisions.

Wellpoint Medical Policies and Clinical UM Guidelines

Provider tools and resources

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