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2 | | No | No | No | No | No | No | Yes | Yes | Yes | No | No | | No Auth is needed if under 500 per line item |
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4 | | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | B | 1. 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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6 | | Yes | Yes | Yes | Yes | | | | | | | | B | Auth Required Initial. 1. Auth Initial 2. Auth Supply- 3. PAP 3rd Month CTP |
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8 | | Yes | Yes | Yes | Yes | No | No | | | | No | | B | Auth Required Initial. 1. Auth Initial 2. Auth Supply 3. PAP 10 Month Rental |
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10 | | Yes | Yes | Yes | Yes | | | | | | | No | B | e0562= NU. PAP= 90 Days. Supplies No Auth. |
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12 | | Yes | Yes | Yes | Yes | | | | | | | No | B | e0562= 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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14 | | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | | e0562= RR. PAP= 90 Days. Supplies No Auth |
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16 | | | NV Medicaid- Amerigroup- Use ABC |
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17 | | No | No | No | No | | | | | | | No | | 1. 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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19 | | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | | ID# starts with R |
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