Nevada
Provider Communications

December 2018 Anthem Provider Newsletter - NV

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Title Category

2019 Medicare Advantage individual benefits and formularies

Medicare

Accessing remittance inquiry beginning December 1, 2018

Medicaid

Affordable Care Act Plans offered in 2019

Administrative

Anthem accepts electronic prior authorization requests for prescription medications online

Pharmacy

Anthem adopts MCG care guidelines for physical health - acute care services and behavioral health services

Medicaid

Anthem works to simplify payment recovery process for National Accounts membership

Administrative

Availity to serve as EDI entry point for electronic submissions

Administrative

Case Management Program

Products & Programs

Claims Requiring Additional Documentation – Reimbursement Policy Update

Medicaid

Clear Claim Connection

Reimbursement Policies

Clinical Practice and Preventive Health Guidelines available on the web

Products & Programs

CMS Medicare Preclusion List effective April 1, 2019

Medicare

Coding spotlight: substance use disorders and smoking

Medicaid

ConditionCare Program Benefits Patients and Physicians

Products & Programs

Coordination of Benefits for an FEP® member

Federal Employee Plan (FEP)

Coordination of Care

Products & Programs

EDI Gateway migration

Medicaid

Health Care Reform Updates (including Health Insurance Marketplace / Affordable Care Act)

Administrative

Important Information about Utilization Management

Products & Programs

Improving the Patient Experience continuing medical education

Medicaid

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare

Integrated Care Model for plans purchased on the Health Insurance Marketplace / Nevada Health Link benefits patients and physicians

Products & Programs

Introducing the new Clinical Criteria page for injectable, infused or implanted drugs

Pharmacy

Keep up with Medicare news

Medicare

Medical Policies and Clinical Utilization Management Guidelines update

Medicaid

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare

Members’ Rights and Responsibilities

Products & Programs

Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period - Professional

Reimbursement Policies

Networks at a Glance

Administrative

New Medicare Advantage provider service phone number beginning January 1, 2019

Medicare

Non-participating lab referrals

Administrative

Pharmacy information available on anthem.com

Products & Programs

Pharmacy information available on anthem.com

Pharmacy

Pharmacy management information

Medicaid

Practitioners’ rights during credentialing process

Medicaid

Prior authorization requirements for Interferon beta-1a

Medicaid

Procedure codes may be denied

Medicaid

Quality Management information

Medicaid

Quarterly pharmacy formulary change notice

Medicaid

Reimbursement for Convenience Surgical Supply Kits - Professional

Reimbursement Policies

Reimbursement Policies are available online

Reimbursement Policies

Remittance Inquiry tool available December 1, 2018

Medicaid

Request a Clinical Appeal through new functionality in our Interactive Care Reviewer (ICR) tool on Availity

Administrative

Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Scope of License - Reimbursement Policy Update (Professional)

Reimbursement Policies

System updates for reimbursement policies in 2019 - Professional

Reimbursement Policies

Update to AIM Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Updated Escalation Contact List

Administrative

Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web

Products & Programs

Vaginal birth after cesarean shared decision-making aid available

Medicaid

When and how to initiate Medicare Advantage reopenings

Medicare

“Rule of Eight” Reporting Guidelines for Physical Medicine and Rehabilitation Services - Professional

Reimbursement Policies
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