• 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

NPI of Ordering, Prescribing and Referring Provider Must be on Claims Effective October 15, 2014 [Web Announcement 814]

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]

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 (Second Quarter 2014 Provider Newsletter) [Read]

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

Web AnnouncementsView All

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.

Claim Billing Field Prior to Change Post Change
Quantity Dispensed (442-E7) 1.000 30.000
Days Supply (405-D5) 30 30
Unit of Measure (600-28) EA ML

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.

Important notes:

  • 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.

Web Announcement 812

ALL PROVIDERS AND STAFF INVITED: Annual Medicaid Conference October 8 in Reno/Sparks and October 16 in Las Vegas

Do not miss your opportunity to attend the Annual Medicaid Conference. Register now to attend one of the half-day morning or afternoon Conferences scheduled for the following dates and locations:

  • Wednesday, October 8, 2014, in Reno/Sparks: JA Nugget Casino Resort, 1100 Nugget Ave., Sparks (in the Rose Ballroom)
  • Thursday, October 16, 2014, in Las Vegas: Palace Station Hotel and Casino at 2411 W. Sahara Ave., Las Vegas (in the Grand Ballroom)

This year there are half-day morning and afternoon sessions at each location. The same content will be included in each session. The morning sessions begin at 8 a.m. and end at 11:45 a.m. (check in starts at 7:30 a.m.). Afternoon sessions begin at 1 p.m. and end at 4:45 p.m. (check in starts at 12:30 p.m.).

Registration is required. You will receive a registration confirmation. Please print your registration confirmation and take it with you to the Medicaid Conference. Your printed confirmation will be entered in a drawing for a giveaway. Conference topics are listed on the registration website at http://starcite.smarteventscloud.com/hp/Annual_Medicaid_Conference_2014.

Like last year’s event, the 2014 Medicaid Conference will be “green.” The presentations will not be printed and distributed; instead, they will be available for downloading and printing from the Provider Training webpage at http://www.medicaid.nv.gov/providers/training/training.aspx following the Conference.

Web Announcement 811

Hydrocodone Combination Products Change to DEA Schedule 2

On August 22, 2014, the Drug Enforcement Administration (DEA) published a final ruling in the Federal Register announcing the rescheduling of Hydrocodone Combination Products from Federal Controlled Substances Schedule III to Schedule II, effective October 6, 2014.

NAC 453.520 of the Nevada Administrative Code has been updated to include hydrocodone as a Schedule II medication.

All available combination hydrocodone products will be affected.

What changes with the Schedule II classification?

  • Hydrocodone prescriptions written after October 6, 2014, will be treated as Schedule II, and will not be allowed to be refilled.
  • Pharmacists will not be able to contact providers to obtain a new prescription by phone or fax.
  • Providers will no longer be able to call or fax prescriptions for hydrocodone-containing medications to the pharmacy. The patient must pick up a brand new prescription from the provider and take the new prescription to the pharmacy.

Please refer to the Federal Register webpage for more information.

Web Announcement 810

ICD-10 Compliance Date Scheduled for October 1, 2015

The ICD-9 code sets used to report medical diagnosis and inpatient procedures will be replaced by ICD-10 code sets on October 1, 2015. Congress delayed the implementation of ICD-10 code sets from October 1, 2014, to October 1, 2015.

ICD-9 codes must continue to be used for all procedures and diagnoses dates of service (outpatient services) or dates of discharge (inpatient services) before October 1, 2015. Claims with ICD-10 codes dates of service or discharge before October 1, 2015, will be rejected.

Providers are advised to talk with your software vendor to ensure your system will be upgraded to support ICD-10 by October 1, 2015. Resources and additional information are available on the CMS ICD-10 website.

Web Announcement 809

Hospital Claims for HCPCS Code G0378 or Revenue Code 0762 or Outpatient CPT Codes that Denied Inappropriately will be Reprocessed

Hospital observation claims that denied inappropriately for same date of service/same facility will be automatically reprocessed. The affected claims:

  • Were for dates of service November 18, 2013, through March 18, 2014; and
  • Were billed with one of the following codes:
    - HCPCS code G0378 (Hospital observation service, per hour) or
    - Revenue code 0762 (Observation hours) or
    - Procedure code on outpatient claim between 10000 and 99999 (excluding ancillary services codes between 99201 and 99499) or
    - Procedure code on outpatient claim between 99281 and 99285 (emergency room visit); and
  • Denied for different National Provider Identifier (NPI) with edit codes 0412 (contradicted – emergency claim exists), 0413 (contradicted – observation claim exists), 0414 (contradicted – inpatient claim exists; from date is same as through date of ER visit) or 0415 (contradicted – inpatient claim exists; from date or through date is the same).

The adjudication of the affected claims will appear on remittance advices dated September 26, 2014.

Web Announcement 808

Claims for Cesarean Section Diagnosis or Procedure Codes

Claims for Cesarean section diagnosis or procedure codes with dates of service on or after April 15, 2013, and processed before November 18, 2013, that were cut back inappropriately from 4 to 3 days (on hospital claims) or were cut back with edit code 0175 (on physician claims paying lower vaginal delivery rate) are being automatically reprocessed. The affected diagnosis codes are 054.1-054.12, 642.5-642.63, 644.2-644.21, 646.2-646.24, 653-654.23, 660-660.93. The affected CPT procedure codes are 59510, 59514 and 59515. The adjudication of the reprocessed claims will appear on remittance advices dated September 26, 2014.

Web Announcement 807

REMINDER: REGISTER NOW for the 2014 Annual Medicaid Conference

Providers are urged to register now for the 2014 Annual Medicaid Conference scheduled for the following dates and locations:

  • Wednesday, October 8, 2014, in Reno/Sparks: JA Nugget Casino Resort, 1100 Nugget Ave., Sparks (in the Rose Ballroom)
  • Thursday, October 16, 2014, in Las Vegas: Palace Station Hotel and Casino at 2411 W. Sahara Ave., Las Vegas (in the Grand Ballroom)

This year there are half-day morning and afternoon sessions at each location. The same content will be included in each session. When providers register, they will be asked to choose either the morning or afternoon session at the location of their choice. The morning sessions begin at 8 a.m. and end at 11:45 a.m. (check in starts at 7:30 a.m.). Afternoon sessions begin at 1 p.m. and end at 4:45 p.m. (check in starts at 12:30 p.m.).

Registration is required. You will receive a registration confirmation. Please print your registration confirmation and take it with you to the Medicaid Conference. Your printed confirmation will be entered in a drawing for a giveaway. Conference topics are listed on the registration website at http://starcite.smarteventscloud.com/hp/Annual_Medicaid_Conference_2014.

Like last year’s event, the 2014 Medicaid Conference will be “green.” The presentations will not be printed and distributed; instead, they will be available for downloading and printing from the Provider Training webpage at http://www.medicaid.nv.gov/providers/training/training.aspx following the Conference.

Web Announcement 806

PayerPath Claim Submission Training for October 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 October 1 7 to 8 a.m.
ADA Friday October 3 7 to 8 a.m.
UB Tuesday October 7 7 to 8 a.m.
CMS-1500 Thursday October 9 7 to 8 a.m.
CMS-1500 Wednesday October 15 7 to 8 a.m.
ADA Tuesday October 21 3 to 4 p.m.
CMS-1500 Thursday October 23 3 to 4 p.m.
UB Tuesday October 28 7 to 8 a.m.
CMS-1500 Thursday October 30 7 to 8 a.m.

*All times indicated are Pacific Time (PT). 

 


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