Nevada
Provider Communications

December 2018 Anthem Provider Newsletter - NV

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Title Category

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

Coordination of Benefits for an FEP® member

Federal Employee Plan (FEP)

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

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

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

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

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

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
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