Web Announcement 780
Attention Provider Types 14 and 82: Reminder Regarding Policy Change for Basic Skills Training
In January 2014, State of Nevada policy regarding Basic Skills Training (BST) was updated. Policy added criteria regarding BST service limitations after six consecutive months. Providers are referred to Medicaid Services Manual (MSM) Chapter 400 Section 403.6C.3 a-d. If a recipient has been receiving BST services for six consecutive months, the provider must validate that continued services are reasonable and necessary. To be considered reasonable and necessary, the following conditions must be met. Adherence is demonstrated throughout the clinical documentation on form FA-11A (Behavioral Health Authorization Request), specifically in section VII Symptoms and Significant Life Events and in section VIII Treatment Plan and Rationale.
MSM Chapter 400 Section 403.6C.3:
a. Expectation that the patient’s condition will improve significantly in a reasonable and predictable period of time, or the services must be necessary for the establishment of a safe and effective rehabilitative therapeutic design required in connection with a specific disease state.
b. The amount, frequency and duration of BST must be reasonable under accepted standards of practice.
c. If the rehabilitation plan goals have not been met, the re-evaluation of the rehabilitation/treatment plan must reflect a change in the goal, objectives, services and methods and reflect the incorporation of other medically appropriate services such as outpatient mental health services.
d. Documentation demonstrates a therapeutic benefit to the recipient by reflecting the downward titration in units of service. The reduction in services should demonstrate the reduction in symptoms/behavioral impairment.
Documentation in the request for review for prior authorization (the PAR) should reflect adherence to the additional criteria noted above.
Web Announcement 779
EVS Eligibility Responses for Health Care Guidance Program
The Electronic Verification System (EVS) was updated on July 28, 2014, to return CMO Eligibility information for recipients that are part of the Health Care Guidance Program. The examples below show how this information will be provided based on the method that is used to check eligibility. For more information regarding the Health Care Guidance Program refer to Web Announcement 742.
The IVR system will now advise callers that the recipient is part of CMO care management.
EDI 270/271 Batch and Real Time:
The X12 271 Health Care Eligibility Benefit Response will now display CMO CAREMGMT in the Plan Coverage Description field (EB05).
Provider Web Portal:
Eligibility Verification Request
Web Announcement 778
Personal Care Services (Provider Types 30 and 83) Enrollment Checklist Requirements
The Provider Enrollment Checklists for provider type (PT) 30 (Personal Care Services – Provider Agency) and PT 83 (Personal Care Services – Intermediary Service Organization) have been updated. The updated checklists must be returned with provider enrollment and re-enrollment applications received by HP Enterprise Services on or after August 1, 2014. Applications received on or after August 1, 2014, that are not submitted with the current checklist will be returned. The current checklists are indicated with an updated date of 07/17/2014.
Provider Enrollment Checklists are available on the Provider Enrollment webpage at www.medicaid.nv.gov.
Web Announcement 777
Medicaid Services Manual Updated
Changes to the following Medicaid Services Manual (MSM) chapters were approved at a Division of Health Care Financing and Policy (DHCFP) Public Hearing held on July 10, 2014, and are effective August 1, 2014.
- MSM Chapter 600 – Physician Services
- MSM Chapter 800 – Laboratory Services
Please review the updated MSM chapters on the DHCFP website. The schedule and agendas for future hearings are on the DHCFP’s Public Notices webpage.
Web Announcement 776
PayerPath Claim Submission Training for August 2014
The HP Enterprise Services’ Electronic Data Interchange (EDI) department has scheduled virtual room training sessions for providers who have recently signed up to use PayerPath for their Nevada Medicaid claim submissions. This training will cover claim set up, submission, reviewing your claims, reporting and remittance advice review.
In order to participate in the training, you will need to select a date from the calendar below for the claim form you use and send in your request with your name, National Provider Identifier (NPI) and contact information to the following email address: email@example.com. Please send in your request at least 5 days prior to the training you have selected as space is limited. If you have any questions, please call the EDI department: (877) 638-3472, option 2, option 0 and option 3.
A confirmation email will be sent to you with the conference line for the training as well as the link you will use to access the virtual room for the training session.
||7 to 8 a.m.
||3 to 4 p.m.
||7 to 8 a.m.
||7 to 8 a.m.
||7 to 8 a.m.
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*All times indicated are Pacific Time (PT)
Web Announcement 775
Verify Recipient Eligibility Before Submitting Prior Authorization
Providers are reminded to verify recipient eligibility before submitting a prior authorization request.
Providers may now perform an eligibility inquiry through the Provider Web Portal online prior authorization system using CAQH CORE Service Type codes and receive eligibility responses that include the CAQH CORE Service Type codes. Web Announcement 688 provides the steps for performing an eligibility inquiry in the Provider Web Portal using CAQH CORE Service Type codes.
The other options available to providers for verifying recipient eligibility are:
- Electronic Verification System (EVS): To access EVS, visit the Nevada Medicaid website at www.medicaid.nv.gov. Select the “EVS” tab to review the User Manual and to register or login to EVS. EVS is available 24 hours a day, 7 days a week, except during maintenance periods. For assistance with obtaining a secured login, contact the HP Enterprise Services Field Representatives at NevadaProviderTraining@hp.com or by calling (877) 638-3472. Select option 2 for provider, then option 0, then option 4 for Provider Training.
- Automated Response System (ARS): To access ARS, call (800) 942-6511. The ARS provides eligibility information via the phone. Your NPI/API is required to log on.
- Swipe Card System: To implement a swipe card system, please contact a swipe card vendor directly. Vendors that are certified to provide this service are listed in the Service Center Directory located on the Electronic Claims/EDI webpage.
During periods when the above tools are not functioning, providers may contact the Customer Service Center by calling (877) 638-3472. Select option 2 for provider, then option 0, then option 2. Please have your servicing NPI, or API, recipient’s Medicaid ID and date of service for the claim available.
Web Announcement 774
Ordering, Prescribing and Referring Provider Enrollment Requirement to be Implemented August 18, 2014
Effective August 18, 2014, the Division of Health Care Financing and Policy is implementing the requirement for Ordering, Prescribing and Referring (OPR) providers to be enrolled in Nevada Medicaid.
Effective with claims received by HP Enterprise Services (HPES) on or after October 15, 2014, the National Provider Identifier (NPI) of the Ordering, Prescribing or Referring (OPR) provider must be included on all Nevada Medicaid/Nevada Check Up claims or those claims will be denied.
In order for Medicaid to reimburse for services or medical supplies that require a provider’s order, prescription or referral, the Affordable Care Act (42 CFR Parts 405, 447, 455, 457 and 498) requires that the ordering, prescribing or referring provider be enrolled in Medicaid. Providers may enroll by submitting a Provider Enrollment Application for Ordering, Prescribing and Referring Providers, which is posted on the Provider Enrollment webpage at www.medicaid.nv.gov.
Again, if the NPI of the ordering, prescribing or referring provider noted on the claim is not enrolled in the Nevada Medicaid program, for claims processed on or after October 15, 2014, the claim will not be paid.
Please note: The NPI on the OPR Enrollment Application must be for an individual physician or non-physician practitioner (not an organizational NPI).
Web Announcement 773
Attention Provider Types 30 and 83: Functional Assessment Service Plan Tool Updates Effective August 1, 2014
The Nevada Medicaid Personal Care Services (PCS) Functional Assessment Service Plan (FASP) tool and instructions have been updated and will go into effect August 1, 2014. PCS provider agencies and intermediary service organizations (provider types 30 and 83) please note the following details:
1. The FASP is now one document. The PCS provider agency will receive one complete document.
2. The PCS provider agency must provide a copy of the FASP to the recipient.
a. Documentation must be maintained showing that the recipient has received a copy of their FASP.
3. Your new FASP will indicate the number of days per week and the recommended number of visits per day. This information should be taken into consideration when determining any flexibility of services and your plan of care.
a. Days per week and/or hours per day cannot be bundled, and must meet the medical necessity intended on the FASP.
b. Documentation must be maintained showing that the recipient has agreed upon any flexibility of services.
c. Documentation should be maintained that the PCS provider has discussed with the recipient how their needs will be met based on the covered tasks indicated on the FASP.
4. The new FASP is available at this link: Functional Assessment NMO-7073. Please note the following:
a. Box 16 will provide the actual breakdown of time by each task. If the task shows zeros, this task is not an authorized task on your FASP.
b. Box 17 should be reviewed for any additional time that has been authorized due to special circumstances. If this is used, it will include the time from Box 16, as well as any additional authorized time and the specific task for which it was authorized.
c. Box 18 will provide you with the final total authorized hours, as well as the total number of days per week, and the suggested number of visits per day.
d. NOTE: Although you are receiving specific amount of time per task, you are still able to use the flexibility of services policy to best meet the needs of the recipient.
5. The courtesy authorization page will no longer be faxed with the FASP. Agencies must utilize the Electronic Verification System (EVS) to obtain their prior authorization number and to view authorized units and authorized dates of service. Verification of eligibility remains the provider’s responsibility. To access EVS, visit the Nevada Medicaid website at www.medicaid.nv.gov. Select the “EVS” tab to review the User Manual and to register or login to EVS. For assistance with obtaining a secured login or accessing EVS, contact the HP Enterprise Services Field Representatives at NevadaProviderTraining@hp.com.
6. For a variety of reasons assessments are sometimes delayed; the provider agency should verify a recipient’s prior authorization utilizing EVS before calling HP Enterprise Services (HPES) to check the status. Services are never ended or reduced without providing advanced notice, unless the recipient has been admitted to a facility, group home or other entity that includes personal care services.