Nevada expanded applied behavioral analysis services to all ages

At a glance:

• Senate Bill 191 removed all age limits for recipients of applied behavioral analysis (ABA) services.
• All procedure codes billable by Provider Type 85 have been updated in the Medicaid Management Information System (MMIS) to reflect this change.
• Prior authorization requirements remain unchanged, but Anthem is transitioning to the Availity Essentials Authorization app to streamline the process.

During the 2023 Nevada Legislative Session, Senate Bill 191 was passed, removing all age limits on recipients receiving ABA services.

Per this requirement, the following update was effective on or after April 1, 2024:

• All procedure codes billable by provider type (PT) 85 (applied behavioral analysis) have been updated in the MMIS to allow recipients of any age to receive ABA services, so long as those members meet medical necessity criteria.

This applies to:

• Members who meet all the required criteria under the Nevada Medicaid Services Manual for ABA services (MSM Chapter 3700).

This applies to the following provider types:

• Provider Type 85

This applies to the following procedure codes:

• 97151
• 97152
• 0362T
• 97153
• 97154
• 97155
• 97156
• 97157
• 97158
• 0373T

or

• All procedure codes billable by provider type (PT) 85 (Applied Behavioral Analysis)

The following update does not change the procedure for obtaining authorization for ABA services, and providers should continue to submit ABA requests following the current utilization management process.

Provider guidance for submitting authorization requests

The following links will provide support in our authorization processes:

• Provider orientation
• PA requirements
• Prior authorization (PA) requirements will remain the same; the policy for PAs is not changing.
• Behavioral health forms

Availity

Anthem is transitioning to the Availity Essentials Authorization application. You may already be familiar with the Availity Essentials multi-payer Authorization app because thousands of providers are already using it for submitting prior authorizations for other payers. We are eager to make it available to our providers, too.

Interactive care reviewer (ICR) is still available.

If you need to refer to an authorization submitted through ICR, you will still have access to that information. We’ve developed a pathway to access your ICR dashboard. You will simply follow the prompts provided through the Availity Essentials Authorization app. To make it even more convenient, you can pin your authorizations from the ICR application to your Availity Essentials Authorization app dashboard.

Innovation in process

While we grow the Availity Essentials Authorization app to provide you with Anthem-specific information, you may still need to access ICR for:

• Appeals.
• Behavioral health authorizations and inquiries.
• Federal Employee Program^® authorizations and inquiries.

Notices in the Availity Essentials Authorization app will guide you through the process for accessing ICR for alternate authorization and appeals functions.

Training is available

If you aren’t already familiar with the Availity Essentials Authorization app, training is available. Visit the Digital Solutions Learning Hub to access on-demand training, recorded webinars, and other training resources.

Now, give it a try

Accessing the Availity Essentials Authorization app is easy. Ask your organization’s Availity Essentials administrator to ensure you have the Authorization role assignment. Without the role assignment, you will not be able to access the Authorization application. Then, log onto https://Availity.com to access the app through the Patient Registration tab by selecting Authorizations and Referrals.

If you have questions about this communication or need assistance with any other item, contact your local provider relationship management representative or call Provider Services at 844-396-2330.

To join the network, visit: carelonbehavioralhealth.com/providers/join-our-network.

If you have questions, contact Carelon Behavioral Health, Inc. via email at provider.inquiry@carelon.com or through their website.

Note: Prior authorization requests for certain services may require additional documentation to determine medical necessity.