Nevada
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guideline (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) (Professional) (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

Reimbursement policy update: Virtual Visits (professional and facility)

December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

RETRACTION: Inpatient Facility Transfers reimbursement policy (facility)

December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams (professional)

December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

Medical Policy and Clinical UM Guidelines updates

November 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Nov 1, 2021

Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation (professional)

November 2021 Anthem Provider News - Nevada Reimbursement Policies Nov 1, 2021

Clarification: Anthem’s enhanced claim edits for outpatient facility claims

October 2021 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2021

Reimbursement policy clarification: Claims Requiring Additional Documentation (facility)

October 2021 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2021

New reimbursement policy: Multiple and Bilateral Surgery Processing (facility) (MAC)

Material adverse change (MAC)

October 2021 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2021

Medical policy and clinical UM guidelines notification (MAC)

Material adverse change (MAC)
October 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Oct 1, 2021

Reimbursement policy update: Sexually Transmitted Infections Testing (Professional) (MAC)

Material adverse change (MAC)
September 2021 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2021

Reimbursement policy update: Drug Screen Testing (Professional) (MAC)

Material adverse change (MAC)
September 2021 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2021

New reimbursement policy update: Inpatient Facility Transfers (Facility) (MAC)

Material adverse change (MAC)
September 2021 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2021

New clinical guideline: Home Parenteral Nutrition, effective November 1, 2021

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Aug 1, 2021

Transition to AIM Specialty Health Imaging of the heart clinical appropriateness guideline for Computed Tomography to Detect Coronary Artery Calcification

August 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Aug 1, 2021

Pre-service/prior authorization clinical review update: August 1, 2021

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Aug 1, 2021

Reimbursement policy update: claims requiring additional documentation (facility)

August 2021 Anthem Provider News - Nevada Reimbursement Policies Aug 1, 2021

Reimbursement policy update: Distinct Procedural Service, modifiers 59 and XE, XP, XS, & XU

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Reimbursement Policies Aug 1, 2021

Reimbursement policy update: Virtual Visits (professional and facility)

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Reimbursement Policies Aug 1, 2021

New reimbursement policy: Non-Patient Laboratory Services (facility)

Material adverse change (MAC)
July 2021 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2021

Reimbursement policy update: Consultations (professional)

Material adverse change (MAC)
July 2021 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2021

Change notification to medical policies and clinical utilization management guidelines

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM advanced imaging clinical appropriateness guideline

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM musculoskeletal program clinical appropriateness guidelines

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2021

Reimbursement policy update: Emergency Department: Leveling of Evaluation and Management Services (facility)

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Reimbursement Policies Jun 1, 2021

Evaluation and management services correct coding (professional)

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Reimbursement Policies Jun 1, 2021

Anthem to enhance claim edits for outpatient facility claims

June 2021 Anthem Provider News - Nevada Reimbursement Policies Jun 1, 2021

Update to AIM Specialty Health Oncologic Imaging Clinical Appropriateness Guidelines

May 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines May 1, 2021

Reimbursement policy reminder: Readmission (Facility)

May 2021 Anthem Provider News - Nevada Reimbursement Policies May 1, 2021

Reimbursement policy update: Frequency Editing (Professional)

May 2021 Anthem Provider News - Nevada Reimbursement Policies May 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation (Facility) (MAC)

Material Adverse Change (MAC)
May 2021 Anthem Provider News - Nevada Reimbursement Policies May 1, 2021

MCG Care Guidelines 25th Edition (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Apr 1, 2021

Clinic Charges (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Apr 1, 2021

Newborn Inpatient Stays (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Apr 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery Guideline

March 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Mar 1, 2021

Medical Policy and Clinical UM Guideline Updates (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Feb 1, 2021

Emergency Room Transfers (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Feb 1, 2021

Treatment Rooms with Office Evaluation and Management Services (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Feb 1, 2021

MCG care guidelines 24th Edition Customization (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Jan 1, 2021

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Jan 1, 2021

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

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Guidelines for Reporting Timed Units: Physical Medicine and Rehab Services (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Modifier Rules (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Unit Frequency Maximum for Drugs and Biologic Substances (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Multiple Diagnostic Imaging Procedures (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

System updates impacting Professional reimbursement policies for 2021

January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Outpatient System updates for Facility reimbursement policies 2021

January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Clinical practice and preventive health guidelines available on anthem.com

December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Cardiology (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Radiation Oncology (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines

December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

Bundled Services and Supplies (Professional Reimbursement Policy) -- Update

December 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Dec 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Nov 1, 2020

REMINDER: Post-service reviews using AIM

November 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Nov 1, 2020

Documentation Standards for Episodes of Care (Professional Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Nov 1, 2020

Modifier Rules (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Nov 1, 2020

Bundled Services and Supplies (Professional Reimbursement Policy) – Update (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Nov 1, 2020

Claims editing update for ICD-10-CM Excludes 1 notes

November 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Nov 1, 2020

REMINDER: Expansion of AIM Musculoskeletal Program Effective November 1, 2020

October 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Oct 1, 2020

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines delayed

October 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Oct 1, 2020

Laboratory and Venipuncture Services (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
October 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Oct 1, 2020

Reimbursement policy update -- Claims Requiring Additional Documentation policy (Facility)

October 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Oct 1, 2020

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

Material Adverse Change (MAC)
September 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Sep 1, 2020

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

Material Adverse Change (MAC)
September 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Sep 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
August 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Aug 1, 2020

Medical Record Standards

August 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Aug 1, 2020

Reimbursement policy update -- Claims Requiring Additional Documentation (Facility)

August 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Aug 1, 2020

UPDATE: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and Setting determinations (MAC)

Material Adverse Change (MAC)
July 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Jul 1, 2020

New MCG 24th Edition Guidelines

July 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Jul 1, 2020

Transition to AIM Clinical Appropriateness Guidelines -- Rehabilitative Services (MAC)

Material Adverse Change (MAC)
June 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Jun 1, 2020

Nurse Practitioner and Physician Assistant Service (Professional Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
June 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jun 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines May 1, 2020

Pre-Service/Prior Authorization Clinical Review Update -- May 2020 (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines May 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines May 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Sleep Disorder Management (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines May 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- MSK Interventional Pain Management (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Musculoskeletal Program Joint Surgery Clinical Appropriateness Guidelines

May 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines May 1, 2020

Claims requiring additional documentation (Facility Reimbursement Policy -- Update for Inpatient and Outpatient) (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies May 1, 2020

Reminder about System Updates

May 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies May 1, 2020

MCG Care Guidelines 24th Edition (MAC)

Material Adverse Change (MAC)
April 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Apr 1, 2020

Important Update: Milliman Care Guideline (MCG), 23rd Edition, ORG -- W0163 Pelvic Organ Prolapse Repair

March 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Mar 1, 2020

Pre-Service/Prior Authorization Clinical Review Update -- February 2020 (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Feb 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Musculoskeletal Program: Joint Surgery and Spine Surgery (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Feb 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging: Vascular Imaging (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Feb 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Feb 1, 2020

Clinical Laboratory Improvement Amendments (CLIA) claim requirements effective May 1, 2020 (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates - Nevada Reimbursement Policies Feb 1, 2020

Important Update: Milliman Care Guideline (MCG), 23rd Edition, Pelvic Organ Prolapse Repair (MAC)

Material Adverse Change (MAC)
January 2020 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Jan 1, 2020

Outpatient facility edit implementation effective April 26, 2020 (MAC)

Material Adverse Change (MAC)
January 2020 Anthem Provider News and Important Updates - Nevada Reimbursement Policies Jan 1, 2020

Medical Policy and Clinical UM Guidelines notification (MAC)

Material Adverse Change (MAC)
December 2019 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Dec 1, 2019

System updates for 2020 (Professional)

December 2019 Anthem Provider News and Important Updates - Nevada Reimbursement Policies Dec 1, 2019

New Reimbursement Policies (Professional): Durable Medical Equipment - Rent to Purchase and Durable Medical Equipment - Modifiers

December 2019 Anthem Provider News and Important Updates - Nevada Reimbursement Policies Dec 1, 2019

Additional improvements coming to anthem.com regarding Medical Policies and Clinical Guidelines

November 2019 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Nov 1, 2019

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging of the Abdomen and Pelvis (MAC)

Material Adverse Change (MAC)
November 2019 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Nov 1, 2019

AIM Specialty Health Clinical Appropriateness Guidelines update -- Radiation Therapy (MAC)

Material Adverse Change (MAC)
November 2019 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Nov 1, 2019

AIM Specialty Health Clinical Appropriateness Guidelines update -- Musculoskeletal Program Spine Surgery (MAC)

Material Adverse Change (MAC)
November 2019 Anthem Provider News and Important Updates - Nevada Medical Policy & Clinical Guidelines Nov 1, 2019
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