ANTHEM

myNEXUS | Anthem PAC-IM Program

myNEXUS is proud to announce its partnership with Anthem, Inc. to provide utilization management for in-patient post-acute services in the states of CA, CO, CT, GA, KY, IN, ME, MO, NH, NJ, NM, NV, NY, OH, TN, TX, VA, WA, and WI. Please find important announcements, documents, and forms listed below.

Current Announcements:

November 1st, 2022 | Delegation Information:

  • Delegation: Effective  November 1st, 2022, myNEXUS will manage of in-patient post-acute care services in the states of NJ, NY, TN, and TX. Delegated services include Utilization Management.
  • Notice: The delegation notice and orientation letter mailed to facilities is available below by market:
  • Orientation Sessions: myNEXUS is offering training sessions to orient you and your staff with our program. Please register for an orientation online here.
  • Portal registration is not available until October 30th for the November 1st delegation.

September 1st, 2022 | Delegation Information:

  • Delegation: Effective September 1st, 2022, myNEXUS will manage of in-patient post-acute care services in the states of CA, CO, CT, GA, KY, ME, MO, NH, NM, NV, OH, VA, WA, and WI​​​​​​​. Delegated services include Utilization Management.
  • Notice: The delegation notice and orientation letter mailed to facilities is available below by market:
  • Orientation Sessions: myNEXUS is offering training sessions to orient you and your staff with our program.

    • Please register for an orientation online here.

July 1st, 2022 | Delegation Information:

  • Delegation: Effective July 1st, 2022, myNEXUS began management of in-patient post-acute care services in the state of Indiana. Delegated services include Utilization Management.
  • Notice: The delegation notice and orientation letter mailed and emailed to facilities is available here.
  • Orientation Sessions: Orientation training sessions have now ended. A recording of a previous session can be found in the myNEXUS Provider Portal or by emailing Provider_Network@myNEXUScare.com.

Provider Information Form:

  • PAC-IM Facilities (SNF, IRF, LTACH only): Please ensure you are registering for the portal under the “Post-Acute Facility” option. If your facility information is not available in the myNEXUS portal, please complete the “Provider Information Form” found online here.
    • Please note, NJ, NY, TN, and TX facilities participating in the November 1st delegation cannot register for the portal until October 30th.


Authorization Program Materials:

In-Scope Plans:
In-Scope Plan List: The list of in-scope plans, including the September 1st states.

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

Authorization Requests:
myNEXUS Provider Portal: myNEXUS encourages providers to utilize the online Provider Portal to submit authorization requests.
The portal is not available for the November 1st delegation until October 30th.

Fax Request Forms: Initial and continued stay request fax forms can be found below by setting type:

Fax Forms for Skilled Nursing Facilities (SNF):
SNF Initial Request Fax Form
SNF Continued Stay Request Form

Fax Forms for Inpatient Rehabilitation Facilities (IRF):
IRF Initial Request Fax Form
IRF Continued Stay Request Form

Fax Forms for Long-Term Acute Care Hospitals (LTACH):
LTACH Initial Request Fax Form
LTACH Continued Stay Request Form

 

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 PACprovider_network@myNEXUScare.com.

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

Phone: 1-844-411-9622
Fax: 1-833-311-2986