Important information about utilization management
You can request a free copy of our UM criteria from Provider Services at 1-844-396-2330 . Providers can discuss a UM denial decision with a physician reviewer by calling us toll free at the number listed below. To access UM criteria online, go to https://mediproviders.anthem.com/nv/pages/medical-policies.aspx.
We are staffed with clinical professionals who coordinate our members’ care and are available 24/7 to accept precertification requests. Secured voicemail is available during off-business hours. A clinical professional will return your call within the next business day. Our staff will identify themselves by name, title and organization name when initiating or returning calls regarding UM issues.
You can submit precertification requests by:
- Faxing to:
- For DME, PT/OT/ST, pain management, home care, home infusion, hyperbaric treatment or wound care: 1-866-920-8362
- All other, including elective IP and OP services: 1-800-964-3627
- Calling us at 1-844-396-2330
- The Availity Portal at https://www.availity.com*
Have questions about utilization decisions or the UM process?
Call our clinical team at 1-844-396-2330 Monday through Friday from 8 a.m. to 5 p.m. Pacific time.
July 2020 Anthem Provider News and Important Updates -- Nevada