![]() OCR has enforcement authority with respect to health programs and activities that receive Federal financial assistance from the Department of Health and Human Services (HHS) or are administered by HHS or any entity established under Title I of the Affordable Care Act or its amendments. (age), or Section 504 of the Rehabilitation Act of 1973, 29 USC § 794 - PDF (disability), under any health program or activity, any part of which is receiving Federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments. PDF (sex), the Age Discrimination Act of 1975, 42 USC § 6101 et seq. PDF (race, color, national origin, sex, age, sexual orientation, gender identity, and disability), Title IX of the Education Amendments of 1972, 20 USC § 1681 et seq. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling myNEXUS at 84 or by emailing contact the myNEXUS Provider Network Team with any questions at Phone: 1-84Īn individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964, 42 USC § 2000d et seq. MyNEXUS utilizes CMS National and Local Coverage Determinations (NCD and LCDs) when applicable, or Anthem medical policies and clinical Utilization Management guidelines to facilitate the appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. Provider Change Form: Online form providers use to update information. NPI, address, or phone), please submit the Provider Change Form found below. If you are an existing myNEXUS Participating Provider and need to update any of your Provider Information (i.e. Please contact the myNEXUS Claims Team for questions related to the claims process by calling 83. To enroll in the EFT program, please register for EFT payments by completing the online application form:Ĭlaims Forms: Claims Appeal Form for In-Network Providers Claims Appeal Form for Out of Network ProvidersĬlaims Waiver of Liability Form for Out of Network ProvidersĬlaims Notices: NOA Notice: Effective January 1st, 2022 HIPPS Code Notice: Effective April 15th, 2020 RAP Claim Notice: Effective January 1st, 2021 Please find important forms related to the myNEXUS Claims Process listed below.Įlectronic Funds Transfer (EFT) Enrollment: myNEXUS offers EFT payment options for providers. The myNEXUS payer ID for the Anthem delegation is: 34009. This document explains the IV therapy program in detail. Home Infusion (IV) Therapy: Home Infusion (IV) Therapy Information:myNEXUS is not delegated for IV Therapy. Re-Authorization Request Form:Fax form to use for re-authorization requests if needed.įax Confirmation Form: Online Form providers use to confirm their fax numbers for authorization requests. Initial Authorization Request Form:Fax form to use for initial authorization requests if needed. The Provider Portal can be found online here. ![]() Please note Risk plans are not included in this delegation.Īuthorization Requests: myNEXUS Provider Portal: myNEXUS encourages providers to utilize the online Provider Portal to submit authorization requests. In-Scope Plans: In-Scope Plan List:The list of in-scope Anthem plans for the myNEXUS delegation listed by state. Please complete the “Agency Information Form” to have your agency’s information added to the myNEXUS system. Contracting: To become a myNEXUS contracted provider, please complete the form found online here.Orientation Sessions: Please register for an orientation training session online here.Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here. ![]() Delegated services include Utilization Management, Network Management, and Claims Reimbursement.
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