Anthem (Community Care Health Plan of Nevada) Prior Authorization

Anthem (Community Care Health Plan of Nevada) prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Prior authorization/notification is required for many services, with verification available in the Precertification Lookup Tool. Requests can be submitted online through the provider site/Availity, by phone, or by fax. Behavioral health requests have preferred electronic submission and separate fax numbers for outpatient and inpatient paper submissions.
• Requirements vary by service type and network status; some services require notification rather than prior authorization.
• The published bulletin notes out-of-network requirements may differ.
• The lookup tool does not itself reflect benefit coverage or all noncovered services.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• Online via provider website / Availity

• Phone

• Fax

• Behavioral health preferred electronic submission via Availity

• Submission resource 1

• Submission resource 2

Information commonly required

• Member and service-specific code/service lookup should be checked before submission
• Behavioral health outpatient vs inpatient routing differs
• Use provider website to verify prior authorization requirements for specific codes/services

Turnaround notes and caveats

• No specific turnaround time found in the sources reviewed.
• Requirements vary by service type and network status; some services require notification rather than prior authorization.
• The published bulletin notes out-of-network requirements may differ.
• The lookup tool does not itself reflect benefit coverage or all noncovered services.

Provider resources

• Nevada Medicaid provider portal (official)
• Claims overview (official)
• Claims submissions and disputes (official)
• Policies, guidelines and manuals (official)
• Precertification lookup tool (official)
• Electronic Data Interchange (EDI) (official)
• Contact us (official)
• Provider manual (PDF) (official)

Sources