Clinical Utilization Management Criteria (Medicaid - Indiana)
List of adopted Clinical Utilization Management (UM) Criteria and Medical Policies that govern medical necessity determinations for Anthem Medicaid products in Indiana (Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging). Affects providers and contracted groups delivering services to affected Medicaid members.
No material clinical or coverage changes in this revision.
Adopted Clinical Utilization Management Criteria (Indiana Medicaid)
Adopted Clinical UM Criteria (June 27, 2024)
The following Clinical UM Criteria were adopted for Medicaid members (Indiana); detailed criteria are available via the Medical Policy and Clinical UM Guideline subsidiary website or the referenced criteria pages.
Detailed inclusion/exclusion and medical necessity criteria are not included in this document; see referenced criteria pages.
This summary does not enumerate specific exclusion conditions. For explicit exclusions applicable to a service, consult the individual Clinical UM Criteria or Medical Policy page linked for that item. The adopted criteria list and linked subsidiary pages contain the detailed inclusion/exclusion language that governs coverage determinations.
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