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 beneļ¬t 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.
Provider tools and resources
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