Policies, guidelines, and manuals
Access information for assessing coverage options, medical policies, and more.
Provide quality care to our members
Healthy Blue Kansas is committed to supporting you in providing quality care and services to the members in our network. On this page you can access information for assessing coverage options, medical policies, Clinical Utilization Management (UM) Guidelines, clinical practice guidelines and support for delivering benefits to our members.
Provider manuals
Our provider manuals outline key administrative information about our care coordination and UM programs, quality standards for provider participation, claims and appeal guidance, prior authorization requirements, and much more.
Medical Policies and Clinical UM Guidelines
Medical policies address 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.
Related information
Provider Relationship Management Territories
Behavioral Health Provider Relationship Management Territories
For current behavioral health inquiries please email provider.inquiry.ks@carelon.com with your name, NPI and TIN number.