Nevada
Provider Communications

December 2018 Anthem Provider Newsletter - NV

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Title	Category
Case Management Program	Products & Programs
ConditionCare Program Benefits Patients and Physicians	Products & Programs
Integrated Care Model for plans purchased on the Health Insurance Marketplace / Nevada Health Link benefits patients and physicians	Products & Programs
Coordination of Care	Products & Programs
Important Information about Utilization Management	Products & Programs
Pharmacy information available on anthem.com	Products & Programs
Members’ Rights and Responsibilities	Products & Programs
Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web	Products & Programs
Clinical Practice and Preventive Health Guidelines available on the web	Products & Programs
Anthem accepts electronic prior authorization requests for prescription medications online	Pharmacy
Introducing the new Clinical Criteria page for injectable, infused or implanted drugs	Pharmacy
Pharmacy information available on anthem.com	Pharmacy
Request a Clinical Appeal through new functionality in our Interactive Care Reviewer (ICR) tool on Availity	Administrative
Availity to serve as EDI entry point for electronic submissions	Administrative
Anthem works to simplify payment recovery process for National Accounts membership	Administrative
Non-participating lab referrals	Administrative
Affordable Care Act Plans offered in 2019	Administrative
Networks at a Glance	Administrative
Updated Escalation Contact List	Administrative
Health Care Reform Updates (including Health Insurance Marketplace / Affordable Care Act)	Administrative
Update to AIM Clinical Appropriateness Guidelines	Medical Policy & Clinical Guidelines
Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines	Medical Policy & Clinical Guidelines
Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines	Medical Policy & Clinical Guidelines
Reimbursement for Convenience Surgical Supply Kits - Professional	Reimbursement Policies
Scope of License - Reimbursement Policy Update (Professional)	Reimbursement Policies
“Rule of Eight” Reporting Guidelines for Physical Medicine and Rehabilitation Services - Professional	Reimbursement Policies
System updates for reimbursement policies in 2019 - Professional	Reimbursement Policies
Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period - Professional	Reimbursement Policies
Reimbursement Policies are available online	Reimbursement Policies
Clear Claim Connection	Reimbursement Policies
Coordination of Benefits for an FEP® member	Federal Employee Plan (FEP)
New Medicare Advantage provider service phone number beginning January 1, 2019	Medicare
2019 Medicare Advantage individual benefits and formularies	Medicare
CMS Medicare Preclusion List effective April 1, 2019	Medicare
When and how to initiate Medicare Advantage reopenings	Medicare
Individual Medicare plans move compound drugs off formulary beginning January 1, 2019	Medicare
Medicare Part B drugs may include Step Therapy beginning January 1, 2019	Medicare
Keep up with Medicare news	Medicare
Accessing remittance inquiry beginning December 1, 2018	Medicaid
Pharmacy management information	Medicaid
Practitioners’ rights during credentialing process	Medicaid
Claims Requiring Additional Documentation – Reimbursement Policy Update	Medicaid
Remittance Inquiry tool available December 1, 2018	Medicaid
Vaginal birth after cesarean shared decision-making aid available	Medicaid
Anthem adopts MCG care guidelines for physical health - acute care services and behavioral health services	Medicaid
Prior authorization requirements for Interferon beta-1a	Medicaid
Coding spotlight: substance use disorders and smoking	Medicaid
Medical Policies and Clinical Utilization Management Guidelines update	Medicaid
Procedure codes may be denied	Medicaid
Quarterly pharmacy formulary change notice	Medicaid
Improving the Patient Experience continuing medical education	Medicaid
Quality Management information	Medicaid
EDI Gateway migration	Medicaid

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.