Payer policies
Anthem medical policies and clinical UM guidelines
Anthem, part of Elevance Health, publishes two kinds of coverage document: medical policies and clinical utilization management (UM) guidelines. Both are on anthem.com and are selected by state; New York uses anthembluecross.com.
Reimbursement policies and prior authorization code lists are state-specific too. Anthem's Medicaid plans publish their own manuals, policies and guidelines on providers.anthem.com, one page per state.
Where Anthem publishes its policies
Official Anthem pages, checked Oct 25, 2026. Policies change often; always read the version on the payer's site for your date of service.
Policies, guidelines and manuals
Anthem's hub for provider policies and manuals.
Medical policyMedical policies and clinical UM guidelines
Medical policies and clinical UM guidelines, selectable by state.
ReimbursementReimbursement policies
Links to Anthem's state-specific reimbursement policy pages.
Drug policyClinical criteria in pharmacy
Criteria for injectable, infused and implanted drugs covered under the medical benefit.
Prior authorizationPrior authorization
State-specific prior authorization code lists.
MedicaidMedicaid manuals, policies and guidelines (Kentucky example)
Each Anthem Medicaid state has a page like this one for its medical policies and clinical UM guidelines.
Anthem in RCIntel
RCIntel's policy library includes Anthem's commercial medical policies, and the titles of the clinical UM guidelines Anthem's Medicaid plans adopt. You can query them over the API and MCP, or upload any Anthem policy to Payer Intelligence for cited answers.
Ask a Anthem policy a question
Upload a Anthem policy to Payer Intelligence and ask it what you need to know. Every answer cites the section and page it came from.
Common questions
What is the difference between an Anthem medical policy and a clinical UM guideline?
Both describe when Anthem considers a service medically necessary. Medical policies are Anthem's own; clinical UM guidelines are the criteria Anthem uses in utilization review, and its Medicaid plans publish which guidelines they have adopted.
Why does Anthem ask me to pick a state?
Anthem's policies, reimbursement rules and prior authorization lists can differ by state, so the site shows the version for the state where the member's plan is issued.