Nevada
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

Medical Policy and Clinical UM Guidelines notification letter

Material Adverse Change (MAC)
December 2022 Anthem Provider News - Nevada Policy Updates Dec 1, 2022

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update

Material Adverse Change (MAC)
December 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2022

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility (MAC)

Material adverse change (MAC)

December 2022 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2022

Reimbursement policy update: Multiple Surgery - Facility

December 2022 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2022

Reimbursement policy update: Bundled Services and Supplies - Professional

Material Adverse Change (MAC)
December 2022 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2022

Reminder - updated AIM Musculoskeletal program effective January 1, 2023 - site of care reviews

December 2022 Anthem Provider News - Nevada Policy Updates Dec 1, 2022

AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT Code List update (MAC)

Material adverse change (MAC)
December 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2022

Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline

November 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Nov 1, 2022

Improve patient outcomes for colorectal cancer screening with Labcorp’s FIT test

November 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Nov 1, 2022

Correction to reimbursement policy: Place of Service (Facility) (MAC)

Material adverse change (MAC)
November 2022 Anthem Provider News - Nevada Reimbursement Policies Nov 1, 2022

Change notification to Medical Policies and Clinical UM Guidelines (MAC)

Material adverse change (MAC)

October 2022 Anthem Provider News - Nevada Policy Updates Oct 1, 2022

Monkeypox and smallpox vaccines: Product code on claims

This communication applies to the Commercial and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem).
October 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Oct 1, 2022

Reimbursement policy update: Multiple and Bilateral Surgery Processing (Professional)(MAC)

Material adverse change (MAC)
October 2022 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2022

Reimbursement policy update: Three-Dimensional (3D) Radiology Services (Professional & Facility)

October 2022 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2022

Nevada referral management policy

September 2022 Anthem Provider News - Nevada Policy Updates Sep 1, 2022

Medical Policy and Clinical Utilization Management (UM) Guidelines update notification letter (MAC)

Material adverse change (MAC)
September 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Sep 1, 2022

Commercial reimbursement policy update to Modifier 66: Surgical Teams (Professional)

September 2022 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2022

Policy Update: Modifier Rules (Professional) (MAC)

Material adverse change (MAC)

September 2022 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2022

Reimbursement policy update Assistant at Surgery (Modifiers 80, 81, 82, AS) (Professional)

September 2022 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2022

Nevada referral management policy

Nevada referral management policy Policy Updates Aug 5, 2022

Nevada referral management policy

August 2022 Anthem Provider News - Nevada Policy Updates Aug 1, 2022

Nevada referral management policy

All members on a product with referral management will have an attributed PCP within the product parameters.
Nevada referral management policy Policy Updates Jul 7, 2022

Change notification to Medical Policies and Clinical UM Guidelines (MAC)

Material Adverse Change (MAC)
July 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jul 1, 2022

Enhanced reimbursement for voluntary Cancer Care Quality program to be discontinued effective December 31, 2022

July 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jul 1, 2022

Help patients heal from the comfort of home with Hospital in Home care

July 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jul 1, 2022

Reimbursement policy update: Place of Service (Facility)(MAC)

Material adverse change (MAC)
July 2022 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2022

New reimbursement policy: Transitional Care Management (Professional)

July 2022 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2022

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, and XU (Professional)(MAC)

Material adverse change (MAC)
July 2022 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2022

Retraction for reimbursement policy: Sexually Transmitted Infections (Professional)

July 2022 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2022

New reimbursement policy: Modifier FB (Professional & Facility)(MAC)

Material adverse change (MAC)
July 2022 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2022

Reimbursement policy update: Laboratory and Venipuncture Services (Professional & Facility)(MAC)

Material adverse change (MAC)
July 2022 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2022

Reimbursement policy update: Modifier Rules (Professional)(MAC)

Material adverse change (MAC)
July 2022 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2022

Medical Policy and clinical UM guidelines notification update (MAC)

Material adverse change (MAC)
June 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2022

Updates to AIM Specialty Health musculoskeletal clinical appropriateness guidelines (MAC)

Material adverse change (MAC)
June 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2022

Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines (MAC)

Material adverse change (MAC)
June 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2022

Updates to AIM Specialty Health sleep disorder management clinical appropriateness guidelines (MAC)

Material adverse change (MAC)

June 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2022

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services (Facility) (MAC)

Material adverse change (MAC)
June 2022 Anthem Provider News - Nevada Reimbursement Policies Jun 1, 2022

Medical Policy and clinical UM guidelines notification (MAC)

Material adverse change (MAC)
April 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Apr 1, 2022

AIM Specialty Health Outpatient Rehabilitative and Habilitative Services clinical appropriateness guidelines updates (MAC)

Material adverse change (MAC)
March 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Mar 1, 2022

Medical Policy and clinical UM guidelines notification (MAC)

Material adverse change (MAC)
February 2022 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Feb 1, 2022

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guideline (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Dec 1, 2021

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) (Professional) (MAC)

Material adverse change (MAC)
December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

Reimbursement policy update: Virtual Visits (professional and facility)

December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

RETRACTION: Inpatient Facility Transfers reimbursement policy (facility)

December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams (professional)

December 2021 Anthem Provider News - Nevada Reimbursement Policies Dec 1, 2021

Medical Policy and Clinical UM Guidelines updates

November 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Nov 1, 2021

Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation (professional)

November 2021 Anthem Provider News - Nevada Reimbursement Policies Nov 1, 2021

Clarification: Anthem’s enhanced claim edits for outpatient facility claims

October 2021 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2021

Reimbursement policy clarification: Claims Requiring Additional Documentation (facility)

October 2021 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2021

New reimbursement policy: Multiple and Bilateral Surgery Processing (facility) (MAC)

Material adverse change (MAC)

October 2021 Anthem Provider News - Nevada Reimbursement Policies Oct 1, 2021

Medical policy and clinical UM guidelines notification (MAC)

Material adverse change (MAC)
October 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Oct 1, 2021

Reimbursement policy update: Sexually Transmitted Infections Testing (Professional) (MAC)

Material adverse change (MAC)
September 2021 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2021

Reimbursement policy update: Drug Screen Testing (Professional) (MAC)

Material adverse change (MAC)
September 2021 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2021

New reimbursement policy update: Inpatient Facility Transfers (Facility) (MAC)

Material adverse change (MAC)
September 2021 Anthem Provider News - Nevada Reimbursement Policies Sep 1, 2021

New clinical guideline: Home Parenteral Nutrition, effective November 1, 2021

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Aug 1, 2021

Transition to AIM Specialty Health Imaging of the heart clinical appropriateness guideline for Computed Tomography to Detect Coronary Artery Calcification

August 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Aug 1, 2021

Pre-service/prior authorization clinical review update: August 1, 2021

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Aug 1, 2021

Reimbursement policy update: claims requiring additional documentation (facility)

August 2021 Anthem Provider News - Nevada Reimbursement Policies Aug 1, 2021

Reimbursement policy update: Distinct Procedural Service, modifiers 59 and XE, XP, XS, & XU

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Reimbursement Policies Aug 1, 2021

Reimbursement policy update: Virtual Visits (professional and facility)

Material adverse change (MAC)
August 2021 Anthem Provider News - Nevada Reimbursement Policies Aug 1, 2021

New reimbursement policy: Non-Patient Laboratory Services (facility)

Material adverse change (MAC)
July 2021 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2021

Reimbursement policy update: Consultations (professional)

Material adverse change (MAC)
July 2021 Anthem Provider News - Nevada Reimbursement Policies Jul 1, 2021

Change notification to medical policies and clinical utilization management guidelines

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM advanced imaging clinical appropriateness guideline

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM musculoskeletal program clinical appropriateness guidelines

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines Jun 1, 2021

Reimbursement policy update: Emergency Department: Leveling of Evaluation and Management Services (facility)

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Reimbursement Policies Jun 1, 2021

Evaluation and management services correct coding (professional)

Material adverse change (MAC)
June 2021 Anthem Provider News - Nevada Reimbursement Policies Jun 1, 2021

Anthem to enhance claim edits for outpatient facility claims

June 2021 Anthem Provider News - Nevada Reimbursement Policies Jun 1, 2021

Update to AIM Specialty Health Oncologic Imaging Clinical Appropriateness Guidelines

May 2021 Anthem Provider News - Nevada Medical Policy & Clinical Guidelines May 1, 2021

Reimbursement policy reminder: Readmission (Facility)

May 2021 Anthem Provider News - Nevada Reimbursement Policies May 1, 2021

Reimbursement policy update: Frequency Editing (Professional)

May 2021 Anthem Provider News - Nevada Reimbursement Policies May 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation (Facility) (MAC)

Material Adverse Change (MAC)
May 2021 Anthem Provider News - Nevada Reimbursement Policies May 1, 2021

MCG Care Guidelines 25th Edition (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Apr 1, 2021

Clinic Charges (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Apr 1, 2021

Newborn Inpatient Stays (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Apr 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery Guideline

March 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Mar 1, 2021

Treatment Rooms with Office Evaluation and Management Services (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Feb 1, 2021

Medical Policy and Clinical UM Guideline Updates (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Feb 1, 2021

Emergency Room Transfers (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Feb 1, 2021

Guidelines for Reporting Timed Units: Physical Medicine and Rehab Services (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Modifier Rules (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Unit Frequency Maximum for Drugs and Biologic Substances (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Multiple Diagnostic Imaging Procedures (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

System updates impacting Professional reimbursement policies for 2021

January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Outpatient System updates for Facility reimbursement policies 2021

January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

MCG care guidelines 24th Edition Customization (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Jan 1, 2021

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Jan 1, 2021

Frequency Editing (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Jan 1, 2021

Clinical practice and preventive health guidelines available on anthem.com

December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Cardiology (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Radiation Oncology (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines

December 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Dec 1, 2020

Bundled Services and Supplies (Professional Reimbursement Policy) -- Update

December 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Dec 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Nov 1, 2020

REMINDER: Post-service reviews using AIM

November 2020 Anthem Provider News and Important Updates -- Nevada Medical Policy & Clinical Guidelines Nov 1, 2020

Documentation Standards for Episodes of Care (Professional Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Nevada Reimbursement Policies Nov 1, 2020
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