News & Announcements

ER auto-pay list

As part of yearly review of the ER auto-pay diagnosis code listing, some diagnosis codes will be removed from the listing and the ER auto-pay criteria effective as of July 1, 2020.

 

Clinical edit for botulinum toxin and specified drug screening implementation

Effective June 28, 2020, clinical edits will be implemented to approve or deny select services based on Nevada’s Medicaid Services Manual.

 

Clinical edit for obstetric services implementation

Effective June 1 2020, clinical edits will be implemented to approve or deny select services based on the content of the Nevada Medicaid Services Manual.

 

Clinical Criteria Web Posting September 2019

On September 19, 2019, the Pharmacy and Therapeutics (P&T) Committee approved the following Clinical Criteria applicable to the medical drug benefit for Anthem Blue Cross. These policies were developed, revised or reviewed to support clinical coding edits.

 

Shared decision-making aid available

As part of our commitment to provide the latest clinical information and improve member outcomes, we have posted a vaginal birth after cesarean guide

 

Provider Services: 1-844-396-2330

Useful Publications

Useful Links:

Fraud, waste and abuse referrals

Fraud, waste and abuse referrals can be made through the following avenues:

  • Medicare/Medicaid Fraud Hotline
    1-866-847-8247
  • Compliance and Ethics Hotline
    1-877-660-7890
  • Member Fraud, Waste and Abuse
    1-800-600-4441
    medicaidfraud@anthem.com