AdministrativeCommercialJuly 31, 2022

New provider manual available

As of today, the new provider manual is available online. Go to anthem.com, 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

 

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