ANTHEM

myNEXUS | Anthem, Inc. Resources

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:

Tennessee April 1st, 2022 Delegation Information:

  • Upcoming Delegation: Effective April 1st, 2022, myNEXUS will manage 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: myNEXUS is offering training sessions to orient home health agencies with myNEXUS services. There are two different training session options: full sessions covering authorization and claims or a claims only session.
  • Orientation Registration:  Please select the session of your choice below to register.

Agency Information Form:

The agency information form can be 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.
Episodic Authorization Form: Fax form to use for Episodic providers if needed.

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

Out of Network Form: Out of network providers must complete this form to submit 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 either completing the online application form or the paper application form:

Online EFT Application Form
Paper EFT Application Form

Claims Forms:
Claims Appeal Form for In-Network Providers
Claims Appeal 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 Network Provider Change Form to provider_network@mynexuscare.com or via fax to ATTN: Provider Network at (615) 988-9947.

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

Additional Resources:

 

Contact Us:

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 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

Program Documents

Category Document name Description
Program Materials Initial Authorization Request Form Fax form to use for initial authorization requests.
Program Materials Re-Authorization Request Form Fax form to use for re-authorization requests.
Program Materials Episodic Authorization Request Form Fax form to use for Episodic authorization requests.
Program Materials Home Infusion Therapy Information Information on the IV Therapy program.
Program Materials Fax Confirmation Form Form to complete to confirm fax number for authorization requests.
Authorization Portal Registration Guide Click here for more information on how to register for the portal.
Program Announcements In-Scope Plan List Updated Anthem in-scope plan grid for January 2022.
Program Announcements Georgia Provider Notice Important Network Delegation Announcement
Program Announcements Kentucky, Ohio, Virginia Provider Notice Important Network Delegation Announcement
Program Announcements California Provider Notice New Plan Announcement: Effective January 1st, 2019, myNEXUS will manage Group-sponsored Medicare Advantage plans in the states of CA, GA, IN, NH, NY, OH, and WI. Delegated services include Claims Payment, Provider Network, and Utilization Management.
Program Announcements Georgia Provider Notice New Plan Announcement: Effective January 1st, 2019, myNEXUS will manage Group-sponsored Medicare Advantage plans in the states of CA, GA, IN, NH, NY, OH, and WI. Delegated services include Claims Payment, Provider Network, and Utilization Management.
Program Announcements Indiana, New Hampshire, and Ohio Provider Notice New Plan Announcement: Effective January 1st, 2019, myNEXUS will manage Group-sponsored Medicare Advantage plans in the states of CA, GA, IN, NH, NY, OH, and WI. Delegated services include Claims Payment, Provider Network, and Utilization Management.
Program Announcements New York Provider Notice New Plan Announcement: Effective January 1st, 2019, myNEXUS will manage Group-sponsored Medicare Advantage plans in the states of CA, GA, IN, NH, NY, OH, and WI. Delegated services include Claims Payment, Provider Network, and Utilization Management.
Program Announcements Wisconsin Provider Notice New Plan Announcement: Effective January 1st, 2019, myNEXUS will manage Group-sponsored Medicare Advantage plans in the states of CA, GA, IN, NH, NY, OH, and WI. Delegated services include Claims Payment, Provider Network, and Utilization Management.
Program Announcements ABC Notice of Delegation of MA Home Health Network 8.1.2018  Network Delegation: August 1, 2018
Program Announcements ABCBS Notice of Delegation of MA Home Health Network 8.1.2018  Network Delegation: August 1, 2018
Program Announcements Amerigroup Notice of Delegation of MA Home Health Network 8.1.2018  Network Delegation: August 1, 2018
Program Announcements BCBSGa Notice of Delegation of MA Home Health Network 8.1.2018  Network Delegation: August 1, 2018
Program Announcements EBCBS Notice of Delegation of MA Home Health Network 8.1.2018 Network Delegation: August 1, 2018
Program Announcements Introduction and Orientation Letter: Connecticut, Missouri and Virginia Medicare Advantage Phase 2 announcements: All home health service requests for Medicare Advantage members started on or after May 1, 2017 will require prior authorization from myNEXUS. myNEXUS will begin accepting authorization requests on April 17, 2017.
Program Announcements Introduction and Orientation Letter: Blue Cross Blue Shield of Georgia Medicare Advantage Phase 2 announcements: All home health service requests for Medicare Advantage members started on or after May 1, 2017 will require prior authorization from myNEXUS. myNEXUS will begin accepting authorization requests on April 17, 2017.
Program Announcements Introduction and Orientation Letter: Empire BlueCross Medicare Advantage Phase 2 announcements: All home health service requests for Medicare Advantage members started on or after May 1, 2017 will require prior authorization from myNEXUS. myNEXUS will begin accepting authorization requests on April 17, 2017.
Program Announcements Connecticut, Missouri and Virginia Medicare Advantage myNEXUS Home Health Agency Provider – IMPORTANT NETWORK INFORMATION
Program Announcements Blue Cross Blue Shield of Georgia Medicare Advantage myNEXUS Home Health Agency Provider – IMPORTANT NETWORK INFORMATION
Program Announcements Empire BlueCross Medicare Advantage myNEXUS Home Health Agency Provider – IMPORTANT NETWORK INFORMATION
Program Announcements Anthem Blue Cross Blue Shield Colorado, Maine, New Hampshire, Wisconsin Medicare Advantage myNEXUS Home Health Agency Provider – IMPORTANT NETWORK INFORMATION
Program Announcements Amerigroup New Mexico, Washington Medicare Advantage myNEXUS Home Health Agency Provider – IMPORTANT NETWORK INFORMATION
Information Updates Network Provider Change Form Form for myNEXUS Participating Providers to update any of your Provider Information (i.e. NPI, address, or phone).
Claims Forms EFT Enrollment Option 2: Complete the Paper Application To complete EFT enrollment, agencies have the option to complete either the online form or submit a paper form. The myNEXUS Payer ID for Anthem is 34009.
Claims Forms Claims Appeal Form for In-Network Providers Form for in-network Providers to complete for claims appeal options.
Claims Forms Claim Appeal Form for Out of Network Providers Non-participating provider claims appeal request form.