Anthem is committed to helping our members gain timely access to care and services in a way that places the least burden on the health care system. We have established a team of experts to closely monitor developments and how they will impact our members and health care provider partners. Our actions are intended to support the protective measures taken across the country to help prevent the spread of COVID-19 and reduce barriers to seeing a doctor, getting tested and maintaining adherence to medications for long-term health issues.
Get the latest news and information from the CDC at www.cdc.gov/coronavirus.
The following Medicaid Services Manual (MSM) chapter has been updated and posted to the Division of Health Care Financing and Policy (DHCFP) website.
Claims for COVID-19 diagnostic testing procedure code 87426 (Infectious agent antigen detection by immunoassay technique) are not required to be billed with procedure code 87301.
Identifying the most appropriate COVID-19 testing codes, testing sites and type of test to use can be confusing. The guidance here can make it easier for you to refer your patients to high-quality, lower-cost COVID-19 testing sites, find Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem)-contracted laboratories and identify the proper CPT® codes to use.
All encounter-based providers (including but not limited to: Federally Qualified Health Centers, Rural Health Clinics, Indian Health Services and Tribal Clinics, etc.) who seek reimbursement for the administration of a COVID-19 vaccine must do so by using their encounter code and the COVID-19 vaccine administration Current Procedural Terminology (CPT) codes.
The Division of Health Care Financing and Policy (DHCFP) has created three flyers to provide information to Nevada Medicaid recipients on COVID-19 covered services, COVID-19 vaccines, and COVID-19 vaccination prioritization lanes. The DHCFP is asking for Nevada Medicaid providers to assist with providing these flyers to Nevada Medicaid recipients. Page one is in English and page two is in Spanish for each flyer. Providers can print double-sided or email these flyers to Nevada Medicaid recipients.
Attention Provider Types 12 (Hospital, Outpatient) and 43 (Laboratory, Pathology Clinical): Rate Change for COVID-19 Testing Codes U0003 and U0004
Providers who request to enroll with Nevada Medicaid to administer the COVID-19 vaccine must submit an initial application using the following resources.
On December 11, 2020, the U.S. Food and Drug Administration (FDA) approved the Pfizer COVID-19 vaccine for individuals aged 16 years and older for emergency use authorization (EUA). On December 18, 2020, the FDA also approved the Moderna vaccine for EUA for individuals aged 18 years and older.
Researchers from UNR Med, in partnership with the NV Department of Health and Human Services and Immunize NV, are conducting a survey to learn about the public's knowledge about the COVID-19 vaccines.
The Nevada Department of Health and Human Services (DHHS) and its Divisions, including the Division of Health Care Financing and Policy (DHCFP), are concerned about the effect of the pandemic on rates of anxiety, depression and suicide among youth. The Department would like to bring to your attention the importance of the role you play as a provider in mental health screening and early identification of mental and behavioral health difficulties. The DHHS and its Divisions respectfully request that providers make an extra effort to screen all youth more frequently.
Anthem is closely monitoring COVID-19 developments and how the novel coronavirus will impact our customers and provider partners. Click below for the latest information for providers:
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced $20 billion in new funding for providers on the frontlines of the Novel Coronavirus (COVID-19) pandemic.
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 who participate in state Medicaid and the Children's Health Insurance Program (CHIP):
On June 9, 2020, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers who participate in state Medicaid and CHIP programs. HHS is also announcing an additional distribution of Provider Relief Funds to safety net hospitals:
Anthem is closely monitoring COVID-19 developments and what it means for our customers and our health care provider partners. Our clinical team is actively monitoring external queries and reports from the CDC to help us determine what action is necessary on our part. We have made changes to how behavioral health providers can use and be compensated for telehealth (audio + video) and telephonic-only care with their patients.
Anthem announced that effective April 1, 2020, we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. The expansion covers the waiver of cost shares for COVID-19 treatment received through December 31, 2020.
Focusing solely on testing symptomatic patients may not be sufficient to prevent further transmission of COVID-19. Testing expansion is urgently required to determine the impact of asymptomatic cases on viral spread.
Anthem recognizes the intense demands facing doctors, hospitals and all health care providers in the face of the COVID-19 pandemic. Today, unless otherwise required under state and federal mandates as detailed below, Anthem health plans will suspend select prior authorization (PA) requirements, member cost sharing, claims review and handling protocols to allow health care providers to focus on caring for patients diagnosed with COVID-19:
We are committed to helping care providers learn how you can secure resources to support yourselves and your business during the COVID-19 crisis. On April 30, 2020, we hosted a webinar to share information and resources with network providers regarding opportunities to access loans through the U.S Small Business Administration (SBA) and other federal programs in response to the economic impact of COVID-19 on care providers that are also small employers.
During the COVID-19 crisis, care providers are working to keep the country running while navigating the financial impact it is having on them:
Effective March 20, 2020, hydroxychloroquine and chloroquine prescriptions will require a diagnosis code on the prescription. Hydroxychloroquine and chloroquine will be covered only for FDA-approved indications:
Visit the Division of Health Care Financing and Policy website at http://dhcfp.nv.gov/covid19 and the Nevada Health Response website at https://nvhealthresponse.nv.gov for important updates related to COVID-19 and its impact on Nevada Medicaid recipients and providers.
To help address providers’ questions, Anthem has developed the following FAQ list:
Get the answers to these questions and more in our Talking Points PDF:
The latest updates regarding prior authorization requirements will be posted: