As of today, the new provider manual is available online. Go to, and select For Providers. Under the Provider Resources heading, select Policies, Guidelines & Manuals. Select Nevada.

  • To access the manual effective November 1, 2022: Under the Provider Manualheading, select Download the Manual under the banner. This version is effective beginning November 1, 2022, but available for review as of August 1, 2022.
  • To access the manual still effective until October 31, 2022: Select the link titled Access previous versions and other manuals. See the appropriate historical version using the effective dates listed with each manual.

Changes were made to the following sections:

  • Insurance requirements
  • Credentialing
  • Claims submission
  • Medical records submission (solicited and unsolicited)
  • Electronic Data Interchange (EDI)
  • Claim payment disputes
  • Clinical appeals
  • Reimbursement requirements and policies
  • Medical Policies and Clinical Utilization Management (UM) Guidelines
  • Utilization Management
  • AIM Specialty Health®*
  • Quality Improvement Program
  • Member rights and responsibilities
  • Overview of HEDIS®
  • Centers of Medical Excellence
  • Audit and review
  • Fraud, waste and abuse detection



HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield



Featured In:
August 2022 Anthem Provider News - Nevada