Nevada
Provider Communications

September 2019 Anthem Provider News and Important Updates - Nevada

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Title Category

Access requirements for Behavioral Healthcare services

Administrative

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Risk Adjustment Data Validation (RADV) Audit happening now

Administrative

Anthem Contracted Air Ambulance Providers for Nevada

Administrative

Anthem expands specialty pharmacy prior authorization list (MAC)

Material Adverse Change (MAC)
Pharmacy

Anthem launches Sydney on September 1; New app offers better digital health care support to members

Administrative

Claim editing update for Excludes1 notes

Reimbursement Policies

Claims requiring additional documentation facility reimbursement policy update

Reimbursement Policies

Clinical Criteria updates

Medicare

Coming soon: electronic attachments

Medicare

Customizations to the 23rd edition of the MCG Care Guidelines

Medicare

Intensity Modulated Radiation Therapy Planning and Delivery (Professional Reimbursement Policy – New) (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Keep up with Medicaid news

Medicaid

Keep up with Medicare news

Medicare

Maternity Services and Multiple Delivery (Professional Reimbursement Policies – New) (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

New Clinical Guideline: Pneumatic Compression Devices, effective December 1, 2019 (MAC)

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

New HMO product for Las Vegas employer groups -- effective January 1, 2020

Administrative

PCP after-hours access requirements

Administrative

Pharmacy benefit manager change to IngenioRx

Medicare

Pre-Service/Prior Authorization Clinical Review Update -- September 2019 (MAC)

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Provider Transparency Update

Administrative

Reminder: Changes to timely filing requirements coming in October

Administrative
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