NV INSURANCE REFERENCE GUIDE
Auth- ReferenceE0601-CPAPE0470-BIPAPE0471-ASV-ST-AVAPSE0562-HEATED HUMIDIFIERE1390- OXYGEN CONCENTRATOR- NIGHT TIMEE1392- OXYGEN-POC DAY TIMEE0466/E0465- VENTILATOR- NIV-INVASIVEE0483- VESTE0482- COUGHASSISTE0570- NEBULIZERA CODES- PAP SUPPPLIESAuth Request- P= Portal, F= Fax, B= Both, N/A= NoComments
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Revised Date 12-21-20
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Hometown- PPO
NoNoNoNoNoNoYesYesYesNoNoNo Auth is needed if under 500 per line item
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Hometown- HMO
YesYesYesYesYesYesYesYesYesYesYesB1. Auth Initial 2. Auth Initial Supply 3. Auth Resupply 4. PAP 13 Month Rental 5. Hometown PPO E1390- E1392- No Auth is Required
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Prominence
YesYesYesYesBAuth Required Initial. 1. Auth Initial 2. Auth Supply- 3. PAP 3rd Month CTP
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Prominence MC
YesYesYesYesNoNoNoBAuth Required Initial. 1. Auth Initial 2. Auth Supply 3. PAP 10 Month Rental
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Healthscope
YesYesYesYesNoBe0562= NU. PAP= 90 Days. Supplies No Auth.
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PEBP
YesYesYesYesNoBe0562= NU. PAP= 90 Days. Supplies No Auth. 1. Auth Initial 2. Auth Initial Supply 3. No Auth- Resupply 4. PAP 3rd Month CTP
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NV Medicaid
YesYesYesYesYesYesYesYesYesYesNoe0562= RR. PAP= 90 Days. Supplies No Auth
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NV Medicaid- Amerigroup- Use ABC
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BC/BS OF NV- Follows ABC
NoNoNoNoNo1. Check to see if under AIMS 2. Check Availity to see if what plan of Anthem it is (HMO/PPO, BCBS/not, ANTHEM MC advantage or no, etc) PAP= RR, HH= RR 3. R= Federal 4. XE= HMO 5. XE= IFP= No Deductible for DME- Authorization= Yes 6. N= BC/BS OF NEVADA= NO AUTH FOR PAP
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Blue Shield Federal- NV
YesYesYesYesYesYesYesYesYesYesYesID# starts with R
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Teachers Health Trust
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Caremore - NV
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NOT CONTRACTED
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Health Plan of Nevada
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Sierra Health Plan
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Culinary