ANTHEM

myNEXUS | Anthem Home Health Program

myNEXUS is proud to announce its partnership with Anthem, Inc. to provide utilization management for home health services. Please find important announcements, documents, and forms listed below.

Current Announcements:

Claims Appeal Address Update as of 2/1/2022:

  • Please note the myNEXUS claims appeal address has changed to: P.O. Box 4491, Woodland Hills, CA 91365.
  • Claims appeal forms can be found in the “Claims Program Materials” section below. Email submission is encouraged.

Tennessee April 1st, 2022 Delegation Information:

  • Delegation: Effective April 1st, 2022, myNEXUS began managing Amerigroup Medicare Advantage (MA) plans in the state of Tennessee. Delegated services include Utilization Management, Network Management, and Claims Reimbursement.
  • Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.
  • Orientation Sessions: Orientation training sessions have now ended. Please contact Provider_Network@myNEXUScare.com for training information.

 

Agency Information Form:

Please complete the “Agency Information Form” to have your agency’s information added to the myNEXUS system. The form is found online here.

 

Authorization Program Materials:

In-Scope Plans:
In-Scope Plan List: 
The list of in-scope Anthem plans for the myNEXUS delegation listed by state. Please note Risk plans are not included in this delegation.

Authorization Requests:
myNEXUS Provider Portal:
myNEXUS encourages providers to utilize the online Provider Portal to submit authorization requests. The Provider Portal can be found online here.

Initial Authorization Request Form: Fax form to use for initial authorization requests if needed.
Re-Authorization Request Form: Fax form to use for re-authorization requests if needed.

Fax Confirmation Form: Online Form providers use to confirm their fax numbers for authorization requests.

Home Infusion (IV) Therapy:
Home Infusion (IV) Therapy Information: myNEXUS is not delegated for IV Therapy. This document explain the IV therapy program in detail.

 

Claims Program Materials:

The myNEXUS payer ID for the Anthem delegation is: 34009. Please find important forms related to the myNEXUS Claims Process listed below.

Electronic Funds Transfer (EFT) Enrollment:
myNEXUS offers EFT payment options for providers. To enroll in the EFT program, please register for EFT payments by completing the online application form:

Online EFT Application Form

Claims Forms:
Claims Appeal Form for In-Network Providers
Claims Appeal Form for Out of Network Providers

Claims Waiver of Liability Form for Out of Network Providers

Claims Notices:
NOA Notice:
Effective January 1st, 2022
HIPPS Code Notice: Effective April 15th, 2020
RAP Claim Notice:
Effective January 1st, 2021

Please contact the myNEXUS Claims Team for questions related to the claims process by calling 833-241-0428.


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 Provider Change Form found below.

Provider Change Form: Online form providers use to update information.


Additional Resources:

 

Contact Us:

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. 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.

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

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