Anthem (Community Care Health Plan of Nevada) Prior Authorization

Anthem (Community Care Health Plan of Nevada) publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

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