Medical Policies and Coverage

Effective March 15, 2022, medical drug policies will permanently move from this page to the Prior Review and Limitations page. Please submit all requests for the affected medical drugs via the CMM Portal or fax to 1-888-348-7332. For additional information, please view additional updates on the medical drug review process transition.

Medical Policies

Search for medical policies and guidelines and get policy updates.

Medical Policy Search
Medical Policy Updates
Medical Policy Contact Information

Prior Review

Find prior review, or prior plan approval, requirements and instructions for requesting prior review

Important information regarding medical necessity reviews

Appeals

See instructions for filing an appeal and get answers to frequently asked questions.

Provider Appeal FAQs
Medicare Provider Appeals
Member Representation Authorization Form

Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members

Search requirements for BlueCard® eligible members