REFERRALS FOR GUIDED ACCESS HMO (LAS …...REFERRALS FOR GUIDED ACCESS HMO (LAS VEGAS AREA)...

REFERRALS FOR GUIDED ACCESS HMO (LAS VEGAS AREA) Effective January 1, 2020

Anthem Blue Cross and Blue Shield 9133 West Russell Road, Las Vegas, NV 89148 www.anthem.com

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Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

January 13, 2020 RE: New Guided Access HMO Effective January 1, 2020 Dear Provider, Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Nevada (Anthem) are pleased to announce a new product, Guided Access HMO. Guided Access HMO for large and small groups will be accessing Anthem’s HMO Nevada network. Guided Access HMO for Exchange Individual will be accessing the Pathway X HMO network. Guided Access HMO plans will both require a Primary Medical Group selection and Primary Care Physician (PCP) referral to specialists. Referral requests should be submitted through Availity via the Interactive Care Reviewer (ICR) online referral tool, which will be available by January 31, 2020. In the interim, please utilize the Anthem Referral Form and submit the completed form via email ([email protected]) or fax (1-800-763-3142), or call 800-336-7767. Note: The ICR delay until January 31, 2020 applies to referrals only; ICR for authorizations is currently active and available. Please contact our Provider Relations team by email [email protected] or phone 866-767-9846 if you have any questions. Sincerely,

Jacquie Owens Regional Vice President Network Solutions Anthem Blue Cross and Blue Shield

https://anthempc-attachments-west.s3.amazonaws.com/526/Anthem%20Referral%20Form%20NV%20rv%2020200113%20locked.docx


mailto:[email protected]




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New HMO products for Las Vegas Area -- effective January 1, 2020:

Guided Access – HMO (Large and Small Groups) Guided Access – HMO (Exchange Individual)

Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Nevada (Anthem) are pleased to announce a new product, Guided Access HMO, available to large and small group employers in Las Vegas area effective January 1, 2020*. Guided Access HMO will be accessing Anthem’s HMO Nevada network.

HMO Nevada network (Large and Small Group) alpha prefix YFY, YFF, YFN Anthem has re-entered into the exchange effective January 1, 2020. Guided Access HMO, Exchange Individual will be accessing Anthem’s Pathway X HMO network.

Pathway X HMO network (Exchange-Individual) alpha prefix GZL, GYZ Both products will require a Primary Medical Group selection and Primary Care Physician (PCP) referrals. Please note the ID cards below are just samples, and do not include actual member information such as copays. That information will be included when the ID cards are generated and sent to members prior to the effective date. Sample Guided Access HMO ID card:



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Operational Procedures: Operational procedures for Guided Access HMO are the same as any other Local HMO plan. Please utilize the contact information below: Claims should be filed directly to your Local Blue Cross and Blue Shield office, either electronically or mailed to:

Anthem Blue Cross and Blue Shield P.O. Box 5747

Denver, CO 80217-5747 Online self-service options are available to providers, giving you access to the same information you receive when calling customer service, and provides patient specific information, such as eligibility, benefits, claim status, line-level detail, and payment information. These options include:

Availity: a multi-payer secure provider portal available at availity.com Electronic Data Interchange (EDI): anthem.com/edi Interactive Voice Response (IVR)/Provider Customer Service: is available at 877-833-5742

Referrals for Guided Access HMO:

Submit a referral via one of the following options: o Secure portal: submit referral request through Interactive Care Reviewer (ICR) tool on

the Availity Portal

o Public website: submit the Anthem Referral Form via email (CONVUM-

[email protected]) or fax (1-800-763-3142)

o Phone: 1-800-336-7767

Referrals required for most specialty care o The following specialties or services DO NOT require a referral from PCP to an In-

Network Specialist: Addiction Medicine Applied Behavior Analyst Emergent or Urgent Care Gynecology Licensed Professional

Counselor License Clinical Social

Worker

Midwife Neonatal/Perinatal Obstetrics/Gynecology Ophthalmology Optometry Psychiatry Psychology Retail Health Clinic

As long as the provider is in the HMO or Pathway X HMO network, the referral will be approved.

Referrals must be completed by the member’s PCP

Referrals to a specialist are required for Guided Access HMO members

Specialist to Specialist referrals DO require a referral from the member’s PCP

http://www.availity.com/

http://www.anthem.com/edi






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Submit a Referral via Interactive Care Reviewer (ICR):

Secure portal: submit referral request through Interactive Care Reviewer (ICR) tool on the Availity Portal at Availity.com

http://www.availity.com/



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ICR online Referral release through Availity will be delayed until January 31, 2020, in the interim utilize the online Anthem Referral Form and submit via email or fax, or call 800-336-7767. Note: The ICR delay until January 31, 2020 applies to referrals only; ICR for authorizations is currently active and available. Anthem is dedicated to providing excellent customer service for Guided Access HMO members and their providers. We look forward to building a successful relationship. We appreciate this opportunity to assist you.


REFERRALS FOR GUIDED ACCESS HMO (LAS …...REFERRALS FOR GUIDED ACCESS HMO (LAS VEGAS AREA)...

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