• Nevada Medicaid and Nevada Check Up News [ Read]
  • 2014 Provider Training Catalog [ Review]
  • Preferred Drug List Announcements [ Review]
  • Diabetic Supply Program [ Details ]
  • Save money. Save time. E-Prescribe. [ Details ]
Urgent Notification

CMS-1500 (02-12) Claim Form Must Be Used Effective May 3, 2014

Due to updates to field instructions, providers are encouraged to review the CMS-1500 (02-12) Claim Form Instructions.

  • In Field 24E, the Diagnosis pointers must be alpha characters.
  • In Field 30, the space is labeled as reserved for NUCC use, but the Balance Due is required.

Latest News

URGENT REMINDER: Dual-Use Periods Are Ending for ADA and CMS-1500 Claim Forms; New Forms Must Be Used [Web Announcement 729]

Ordering, Prescribing and Referring Provider Enrollment Requirement to be Implemented August 18, 2014 [Web Announcement 774]

July, August and September 2014 Provider Training [Web Announcement 761]

Nevada Medicaid and Nevada Check Up News (Second Quarter 2014 Provider Newsletter) [Read]

Provider Web Portal Quick Reference Guide (Updated April 16, 2012) [Review]

Web AnnouncementsView All

Web Announcement 793

Nursing Facility Tracking Form

Nursing facilities are instructed to submit a Nursing Facility Tracking Form (available at: https://dhcfp.nv.gov/pdf%20forms/NFTF%20Confirmation%20Page.pdf) for any Fee-For-Service Medicaid recipient, including those on a waiver, at the date of admission. For recipients who are currently enrolled in a Managed Care Organization, the Nursing Tracking Form is required no later than day 46 of the stay. The Medicaid Services Manual will be updated accordingly. Tracking Form instructions are available on the DHCFP Forms webpage at: https://dhcfp.nv.gov/nursing.htm

Web Announcement 792

PayerPath Claim Submission Training for September 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: nvmmis.edisupport@hp.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.

Claim Form Day Date Time*
CMS-1500 Wednesday September 3 7 to 8 a.m.
ADA Friday September 5 3 to 4 p.m.
UB Tuesday September 9 7 to 8 a.m.
CMS-1500 Thursday September 11 3 to 4 p.m.
ADA Tuesday September 16 7 to 8 a.m.
CMS-1500 Thursday September 18 7 to 8 a.m.
UB Tuesday September 23 7 to 8 a.m.
CMS-1500 Thursday September 25 7 to 8 a.m.

*All times indicated are Pacific Time (PT).

Web Announcement 791

CPT Code 90644 (MenHibrix®) is FDA-Approved and is a Vaccines for Children (VFC) Vaccine

CPT code 90644 (MenHibrix® vaccine) was recently approved by the Food and Drug Administration (FDA). Effective with dates of service on or after June 1, 2014, the vaccine is provided free of charge to Vaccines for Children (VFC) providers for eligible recipients age 2 to 15 months.

CPT code 90644 is not reimbursed through Nevada Medicaid/Nevada Check Up. Providers who administer the vaccine must bill the administration code (CPT code 90460, Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component) at the usual and customary charge and bill the vaccine (CPT code 90644) at a zero dollar amount.

Web Announcement 790

Attention Provider Types 20, 24 and 77: Pediatric Enhancement-Surgical Services Claims Reprocessed

Update to Web Announcements 751 and Web Announcement 769: Rates for Pediatric Enhancement-Surgical Services codes for provider type (PT) 20 Physicians, PT 24 Certified Nurse Practitioner and PT 77 Physician Assistant have been updated in the Medicaid Management Information System (MMIS) effective July 1, 2013. Claims with dates of service on or after July 1, 2013, and processed before March 16, 2014, with the previous rates have been reprocessed. The adjudication of the reprocessed claims appears on remittance advices dated August 15, 2014.

Web Announcement 789

Update on Outpatient Therapy Claims that Denied with Edit Code 0303: Medicare Crossover Claims Reprocessed

Update to Web Announcement 757: Medicare crossover claims for outpatient physical, speech, occupational and respiratory therapy services that were submitted with the same date of service, the same recipient and different modifiers that denied with edit code 0303 (Duplicate payment request) have been reprocessed. The affected claims were for dates of service March 21, 2011, through January 25, 2013. The adjudication of the reprocessed claims is reflected on remittance advices dated August 15, 2014.

Web Announcement 788

Health Care Guidance Program Indicator in EVS; Contact Information for Questions

Providers may notice a new indicator in the Electronic Verification System (EVS) that shows a Medicaid recipient is enrolled in the Health Care Guidance Program (HCGP). EVS currently reflects the acronym “CMO-FFS” to indicate Care Management Organization. This indicator is informational only and there are no differences in benefits or billing procedures from any other Fee for Service (FFS) recipient. If you see the CMO indicator and you would like to connect to someone from the Health Care Guidance Program, contact Dr. Amy Khan at (775) 232-9558 or you can e-mail your question to caremanagement@dhcfp.nv.gov.

Web Announcement 787

Updating Inpatient Prior Authorizations in the Provider Web Portal

HP Enterprise Services (HPES) recently updated the online prior authorization system to add new prior authorization (PA) types. (See Web Announcement 755.) When the new Medical/Surgical (M/S) Inpatient and Behavioral Health (BH) Inpatient authorization types were added to the prior authorization system, an issue was identified with updating previously submitted inpatient PA requests that contained facility types that are no longer available. Users were not able to edit the PA and add additional information to PA requests. This issue has been resolved. M/S Inpatient and BH Inpatient prior authorizations with facility types that are no longer available can be updated in the Provider Web Portal.

Web Announcement 786

Provider Type 63 (Residential Treatment Center) Enrollment Checklist Requirements

The Provider Enrollment Checklist for provider type (PT) 63 (Residential Treatment Center – RTC) has been updated. When PT 63 providers enroll or re-enroll, the updated checklist must be completed and submitted along with their Provider Enrollment/Re-Enrollment Packet. The updates align with the policy requirements for Medicaid Services Manual (MSM) Chapter 400, Section 403.8B.

Required documentation includes answers to questions regarding the services the facility provides and the specialties and genders the facility serves. This information will be beneficial for the Division of Health Care Financing and Policy (DHCFP) to understand the nature and capacity of the RTC facility. The form also requires providers to initial sections to acknowledge they have reviewed policy requirements.

For information regarding the policy requirements, please contact Hilary Jones, R.N., HCC III at (775) 684-3753.

Provider Enrollment Checklists are available on the Provider Enrollment webpage at www.medicaid.nv.gov.

Web Announcement 785

Attention Advanced Practice Registered Nurses, Physician’s Assistants and Physician Groups

Advanced Practice Registered Nurses (APRNs) (provider type 24) and Physician’s Assistants (PAs) (provider type 77) are eligible to enroll and participate in Nevada Medicaid/Nevada Check Up. Please see the Provider Enrollment webpage for the Provider Enrollment Information Booklet, Enrollment Checklists for PT 24 and PT 77, and the Provider Initial Enrollment Application Packet (Individuals) (FA-31C).

For APRNs and PAs already enrolled, the Billing Guide for provider types 20, 24 and 77 has been updated and is available on the Provider Billing Information webpage.

Web Announcement 784

Physician/Outpatient-Facility Administered Drug Claims that Previously Denied Have Been Reprocessed

Physician/outpatient-facility administered drug claims that denied for edit code 0012 (Invalid Procedure Code), edit code 0148 (Rendering provider not certified to perform procedure), edit code 0210 (No pricing segment on file), edit code 0309 (Services Not Covered) or edit code 0898 (NDC Code Required) with dates of service on or after September 30, 2011, that processed before October 22, 2012, have been reprocessed. The adjudication of any reprocessed claims was reflected on remittance advices dated July 25, 2014.

Reminder: Effective January 1, 2008, claims for physician/outpatient-facility administered drugs require only the National Drug Code (NDC) and no longer require the HCPCS code.

Web Announcement 783

Provider Type 17 Specialty 215 (SAAM) Claims for Codes H0049, 99408 and 99409

Attention Provider Type 17 (Special Clinic) specialty 215 (Substance Abuse Agency Model - SAAM): Procedure codes H0049 (Alcohol/Drug Screening Services), 99408 (Alcohol and/or Substance Abuse Structured (non tobacco) 15-30 min) and 99409 (Alcohol and/or Substance Abuse Structured (non tobacco) Over 30 min) have been updated in the Medicaid Management Information System. Claims for these codes with dates of service on or after January 10, 2014, that denied for edit code 0210 (No pricing segment is on file) or 0148 (Rendering provider is not certified to perform procedure) have been automatically reprocessed. The adjudication of the reprocessed claims is reflected on remittance advices dated May 16, 2014.

Web Announcement 782

Provider Type 43 May Bill for Hereditary Breast and/or Ovarian Cancer Genetic Testing

Effective with dates of service on or after March 15, 2014, provider type 43 (Laboratory, Pathology/Clinical) may bill the following CPT codes for genetic testing for hereditary breast and/or ovarian cancer mutation:

  • 81211 (BRCA 1 and BRCA 2 gene analysis)
  • 81212 (BRCA 1 and BRCA 2 variants)
  • 81213 (BRCA 1 and BRCA 2 uncommon duplication/deletion variants)
  • 81214 (BRCA 1 gene analysis)
  • 81215 (BRCA 1 known family variant)
  • 81216 (BRCA 2 gene analysis; full sequence analysis
  • 81217 (BRCA 2 known family variant)

All of the codes listed above require prior authorization. Reimbursement rates for provider type 43 are available on the DHCFP Rates Unit webpage at http://dhcfp.nv.gov/RatesUnit.htm.

On this website and on documents posted herein:

Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes, descriptions and data are copyrighted by the American Medical Association (AMA) and the American Dental Association (ADA), respectively, all rights reserved. AMA and ADA assume no liability for data contained or not contained on this website and on documents posted herein.

CPT is a registered trademark ® of the AMA. CDT is a registered trademark ® of the ADA. Applicable FARS/DFARS apply.

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