Provider manuals and guides

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.

Medical Policies and Clinical UM Guidelines

There are several factors that impact whether a service or procedure is covered under a member’s beneļ¬t plan. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary.

Provider tools & resources

Interested in becoming a provider in the Wellpoint network?

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

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