Important information about utilization management
You can request a free copy of our UM criteria from Provider Services at 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:
- Durable medical equipment (DME), physical therapy, occupational therapy, speech therapy, pain management, home care, home infusion requiring nursing services, insulin pumps, hyperbaric treatment, or wound care: 866-920-8362.
- All other inpatient and outpatient services: 800-964-3627.
- Pharmacy prior authorization, including home infusion injectables, continuous glucose monitoring equipment, and diabetic supplies: 844-490-4876.
- Phone: 844-396-2330.
- Pharmacy: 844-396-2330.
- Availity* Essentials: availity.com.
Have questions about utilization decisions or the UM process?Call our Clinical team at 844-396-2330, Monday through Friday, from 8 a.m. to 5 p.m. PT.
November 2022 Anthem Provider News - Nevada