Anthem, Inc. Implementation Resources

myNEXUS is proud to announce its partnership with Anthem, Inc. to provide utilization management for home health services.

Important Announcements:

  • Important COVID-19 Information: With the heightened international awareness regarding the coronavirus disease of 2019 (COVID-19), myNEXUS would like to provide important reminders for your agency. Please find the myNEXUS announcement regarding these reminders on business disruption, which includes infectious outbreaks and other occurrences that potentially impact all of us and consequently, our members/your patients located online here.
  • To view program announcements, please click here.
  • Texas Providers: Effective 12/1, Woundtech will provide wound care services for patients who have persistent, non-healing wounds in the following counties in the state of Texas: Bexar, Dallas/Tarrant, and Harris. Woundtech delivers wound care services at home and alternative residential settings via Nurse Practitioners (NPs) and Physician Assistants (PAs). For more information, please find the notice mailed to your agency online here.

Program Materials:

Please follow the links below for program materials:

In-Scope Plan List

Initial Authorization Request Form
Re-Authorization Request Form
Episodic Provider Authorization Form

Home Infusion Therapy Information

Fax Confirmation Form


 

Claims Forms:

Claims: Appeals Form
Claims: Payment Dispute Form for In-Network Providers
Claims: Payment Dispute Form for Out of Network Providers
myNEXUS Payer ID for Anthem: 34009

EFT Enrollment Options
To complete EFT enrollment, agencies have the option to complete either the online form or submit a paper form:
Option 1: Complete Online Application
Option 2: Complete the Paper Application


Provider Authorization Portal:

myNEXUS Portal
For information on how to register for the portal, please click this link.


Provider Information Updates:

If you are an existing myNEXUS Participating Provider and need to update any of your Provider Information (i.e. NPI, address, or phone), please submit the Network Provider Change Form to provider_network@mynexuscare.com or via fax to ATTN: Provider Network at (615) 988-9947.

Network Provider Change Form


Additional Information:

Anthem Code of Conduct

myNEXUS utilizes CMS National and Local Coverage Determinations (NCD and LCD’s) when applicable, or Anthem medical policies and clinical Utilization Management guidelines to facilitate appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling myNEXUS at 844-411-9622 or by emailing provider_network@myNEXUScare.com.


Contact Us:

Phone: 1-844-411-9622
Fax: 1-844-834-2908

Please contact the myNEXUS Provider Network Team with any questions at provider_network@myNEXUScare.com.