Nevada
Provider Communications

September 2020 Anthem Provider News and Important Updates -- Nevada

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Title Category

Anthem Chat: A fast, easy way to have your questions answered

Administrative

Anthem prior authorization updates for specialty pharmacy are available (MAC)

Material Adverse Change (MAC)
Pharmacy

Anthem to update formulary lists for commercial health plan pharmacy benefit

Pharmacy

Commercial Risk Adjustment (CRA) Reporting Update: 2020 Prospective Program Continues

Administrative

Controlling High Blood Pressure (CBP)

Medicaid

Distinctive Procedural Services, Modifiers 59, XE, XP, XS, XU (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

EDI Gateway Migration Deadline is September 15, 2020

Administrative

Enhanced Medical Records Submission Process to Support Claims Processing

Administrative

Frequency Editing (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Keep up with Medicaid news

Medicaid

Medical drug benefit Clinical Criteria updates (March 2020)

Medicaid

Medical drug benefit Clinical Criteria updates (March 2020)

Medicare

Medical drug benefit Clinical Criteria updates (May 2020)

Medicare

New provider directory indicators for medication assisted treatment (MAT) providers

Administrative

Patient360 Adds Care Gap Alert Feedback for Medical Providers

Administrative

Predictive Analytics guide proactive support to patients undergoing chemo, resulting in lowered admissions

Products & Programs

Receive and respond to medical record requests for postpay audit via Change Healthcare’s Attach Assist functionality

Administrative

Site of Care* medical necessity reviews expand to numerous surgical procedures begin December 1, 2020 (MAC)

Material Adverse Change (MAC)
Products & Programs
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