URGENT REMINDER: Dual-Use Periods Are Ending for ADA and CMS-1500 Claim Forms; New Forms Must Be Used [Web Announcement 729]
Attention Pharmacies: Update Regarding Implementation of Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners [Web Announcement 799]
Nevada Medicaid and Nevada Check Up News (Third Quarter 2014 Provider Newsletter) [Read]
Provider Web Portal Quick Reference Guide (Updated April 16, 2012)
Web Announcement 823
Attention All Inpatient Facilities: Prior Authorization Processes for Inmate Hospitalizations
The following reminders explain the processes for obtaining prior authorization (PA) for hospitalizations for state inmates.
- For emergency hospitalizations: The PA request will be retrospective, unless the recipient is already Medicaid eligible, in which case submit the request as you would for any other recipient.
- For preplanned hospitalizations: Once the date has been set for the procedure, the Nevada Department of Corrections (NDOC) will request Medicaid eligibility. The provider will check as they do for any recipient to see if the recipient is currently eligible prior to admission (when the procedure is scheduled and at admission). If the inmate is eligible, submit the request as you would for any other recipient. If the recipient is not eligible, the request will be retrospective.
Note: The prior authorization request must include the real name and Social Security Number of the inmate.
Nevada Medicaid claims for hospitalization services for inmates are to be submitted to HP Enterprise Services, Attn: Claims, P.O. Box 30042, Reno NV 89520-3042.
Web Announcement 822
Prior Authorization Requirement Updated for Dermatology Codes
Effective with claims with dates of service on or after October 1, 2014, the following dermatology CPT codes do not require prior authorization when billed by any provider type:
Web Announcement 821
PayerPath Claim Submission Training for November 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: firstname.lastname@example.org. 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.
||7 to 8 a.m.
||3 to 4 p.m.
||7 to 8 a.m.
||3 to 4 p.m.
*All times indicated are Pacific Time (PT).
Web Announcement 820
Provider Type 64 (Hospice) Annual Rate Adjustment for Federal Fiscal Year 2015
The federally mandated annual rate adjustment for provider type 64 (Hospice) for Federal Fiscal Year 2015 became effective for claims with dates of service on or after October 1, 2014.
Web Announcement 819
Attention Provider Type 64 (Hospice): Rates for Federal Fiscal Year 2014 Adjusted
The rate increases for provider type 64 (Hospice) services for Federal Fiscal Year 2014 that were effective October 1, 2013, have been adjusted per clarification from the Centers for Medicare & Medicaid Services (CMS).
Hospice claims with dates of service on or after October 1, 2013, that processed prior to September 26, 2014, and that paid at the previous rate will be automatically reprocessed. The adjudication of the reprocessed claims will be reflected on a future remittance advice.
Web Announcement 818
Attention Provider Types 24 and 77: Notice Regarding Claims for Pediatric Enhancement-Surgical Codes
Provider type 24 (Advanced Practice Registered Nurses) and 77 (Physician’s Assistant) claims for pediatric enhancement-surgical services codes 10000-58999 and 60000-69999 have processed inappropriately because the AS modifier was not linked to those codes in the Medicaid Management Information System (MMIS). The affected claims with dates of service on or after July 1, 2013, will be automatically reprocessed. The adjudication of the reprocessed claims will be reflected on a future remittance advice.
Web Announcement 817
Skin Substitute Products Not Covered by Nevada Medicaid
Attention provider types 10, 12, 20, 21, 24, 46, 72 and 77: Effective with claims processed on or after October 1, 2014, HCPCS codes for certain skin substitute products have been end dated in the Nevada Medicaid Management Information System (MMIS). This action is due to Medicare not considering these products as being medically reasonable and necessary, and therefore they are not covered by Nevada Medicaid.
Following is the list of the HCPCS codes that have been end dated in MMIS and are not billable: Q4100, Q4103, Q4104, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4118 and Q4119.
Web Announcement 816
Copaxone® 20 mg Billing Update
Effective September 26, 2014, the billing units for Copaxone® 20 mg kit (NDC 68546-0317-30) changed from 1 kit containing 30 syringes to 30 ML solution for injection.
Nevada Medicaid has updated the quantity limit to allow 30 ML to be submitted where the previous quantity limit was 1 EA kit.
Web Announcement 815
CPT Code 80055 (Obstetric Panel) Not Billable by Provider Type 21 (Podiatrist)
Effective with claims processed on or after September 1, 2014, CPT code 80055 (Obstetric panel) has been end dated in the Nevada Medicaid Management Information System (MMIS) for provider type 21 (Podiatrist). The code was end dated because this procedure is not a service provided by a podiatrist.
Web Announcement 814
NPI of Ordering, Prescribing and Referring Provider Must be on Claims Effective October 15, 2014
Effective for claims received by HP Enterprise Services (HPES) on or after October 15, 2014, the valid National Provider Identifier (NPI) of the Ordering, Prescribing or Referring (OPR) provider must be included on Nevada Medicaid/Nevada Check Up claims or those claims will be denied.
- The following provider types are required to include the NPI of the OPR provider on their claim: 16, 17, 19, 23, 27, 29, 33, 34, 37, 43, 45, 46, 55, 63, 64 and 68.
- The NPI of the OPR provider listed on the claim must be valid. If the NPI of the OPR provider is not a valid NPI, the claim will not be paid.
- If the NPI of the OPR provider is not enrolled in the Nevada Medicaid program, the claim will not be paid.
- The NPI of the OPR provider is mandatory for certain provider types because the services they provide are always ordered or referred. However, for the remaining provider types the OPR provider’s NPI should only be included on the claim when the service being provided has been referred by another provider. Provider types eligible to order and refer include, but are not limited to: 14 (specialty 305), 20, 24, 25, 26 (specialty 162), 74 and 77. Interns, residents and fellows must have an NPI to order, prescribe and refer for Nevada Medicaid recipients.
- If an OPR provider’s NPI is submitted on the claim when it is not mandatory, the NPI will still be validated by the system and the claim will deny if the OPR provider’s NPI is not enrolled in Nevada Medicaid.
- The information in this web announcement is directed to non-pharmacy providers. The impacts of the OPR requirements on pharmacies are detailed in Web Announcement 799.
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.
Web Announcement 813
Provider Type 11: Rate Increase for Psychiatric/Detoxification Revenue Codes
Effective dates of service on or after July 1, 2014, rates for provider type 11 for psychiatric/detoxification revenue codes have increased to $944. The affected codes are 0114, 0116, 0124, 0126, 0134, 0136, 0144, 0146, 0154, 0156 and 0204.
Claims for these codes with dates of service on or after July 1, 2014, and processed before Sept 9, 2014, that paid at the previous rate will be automatically reprocessed. The adjudication of the reprocessed claims will appear on a future remittance advice.