Reimbursement Policies

We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s Nevada Medicaid benefit plan. Keep in mind that determination of coverage under a member’s benefit plan does not necessarily ensure reimbursement. These policies may be superseded by state, federal or CMS requirements. Providers and facilities are required to use industry standard codes for claim submissions. Services should be billed with CPT codes, HCPCS codes and/or revenue codes. The billed code(s) should be fully supported in the medical record and/or office notes. Industry practices are constantly changing, and Anthem Blue Cross and Blue Shield Healthcare Solutions reserves the right to review and revise its policies periodically.

 Anesthesia
 Coding
 DME and Supplies
 Drugs
 Evaluation and Management
 Facilities
 Prevention
 Prosthetics and Orthotics
 Radiology
 Reimbursement Administration - General
 Surgery
 Transportation