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 manuals and quick reference cards
The 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.
- Provider Digital Engagement Supplement
- Medication Therapy Management (MTM)- Provider Operations Manual
- CHOICES Provider Manual Supplement
- Intermediate Care Facility for Individuals with Intellectual Disabilities Provider Quick Reference Guide
- 1915(c) Waiver Program Provider Quick Reference Guide
- Intellectual/Developmental Disabilities Managed Long Term Services and Supports Programs Provider Manual Supplement
- Medicare provider manual
- Medicaid provider manual
- CHOICES Provider Quick Reference Guide
- Provider Quick Reference Guide
- ECF CHOICES Provider Quick Reference Guide
- Community Living Supports (CLS) Provider Manual
Medical policies and clinical UM guidelines
Medical Policy addresses 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.
Wellpoint Medicare Providers, improve your prior authorization and claims submission process. Our new online Clinical Documentation Lookup Tool (CDLT) gives real-time access to the highly recommended medical documents needed with submission.
Access the Clinical Documentation Lookup Tool
Medical Policies and Clinical UM Guidelines
- Gene Therapy for Sickle Cell Disease
- August 2025 Clinical Utilization Management Guidelines
- May 2025 Clinical Utilization Management Guidelines
- February 2025 Clinical Utilization Management Guidelines
- November 2024 Clinical Utilization Management Guidelines
- August 2024 Clinical Utilization Management Guidelines
- May 2024 Clinical Utilization Management Guidelines
- February 2024 Clinical Utilization Management Guidelines
- November 2023 Clinical Utilization Management Criteria
- August 2023 Clinical Utilization Management Criteria
- May 2023 Clinical Utilization Management Criteria
- February 2023 Clinical Utilization Management Criteria
- November 2022 Clinical Utilization Management Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
- Adult Chiropractic Clinical Guideline for Tennessee
- 2025 Clinical Practice Guidelines
- New Clinical Guideline for Rapid Whole Gene Sequencing
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Policies, guidelines & manuals
- Referrals
- Forms
- Training academy
- Pharmacy information
- Electronic data interchange (EDI)
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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