News & Announcements

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In order to communicate more efficiently with providers, Anthem is now sending some bulletins, policy change notifications, prior authorization update information, educational opportunities and more to providers via email. Email is the quickest and most direct way to receive important information from Anthem. To receive email from Anthem (including some sent in lieu of fax or mail), fill out the following form.

 

Personal Care Services and Waiver Services Providers: Important Claims Submission Update

Effective August 24, 2020, the Provider Web Portal (aka the Electronic Verification System [EVS]) will no longer accept new claim submissions by PTs 30, 48, 58 and 83 for services that are required to be provided using an Electronic Visit Verification (EVV) system. Claims need to be submitted through Nevada’s EVV system AuthentiCare® Nevada, as required since September 29, 2019.

 

Behavioral health outpatient treatment specialty 301 (Qualified Mental Health Associate): limitation for code H0034

The U.S. Department of Health and Human Services (HSS) announced the distribution of approximately $15 billion from the Provider Relief Fund to eligible providers that participate in state Medicaid and the Children's Health Insurance Program (CHIP).

 

Deadline for Provider Relief Fund Has Been Extended to August 3, 2020 (July 23, 2020)

The U.S. Department of Health and Human Services (HSS) announced the distribution of approximately $15 billion from the Provider Relief Fund to eligible providers that participate in state Medicaid and the Children's Health Insurance Program (CHIP).

 

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

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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