• 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 ]
Notification

On April 24, 2014, the Customer Service Call Centers will be available from 8:30 a.m. Pacific Time (PT) to 5:30 p.m. PT to allow for staff training. The Call Centers will resume their usual hours of 8 a.m. PT to 5 p.m. PT on April 25.

Latest News

CMS-1500 Claim Form Dual-Use Period Extended: New CMS-1500 (02-12) Must Be Used Effective May 3, 2014 [Web Announcement 713]

April, May and June 2014 Provider Training Reminder [Web Announcement 714]

Attention Pharmacies: Claims adjudication process to validate ordering, prescribing and referring (OPR) practitioners [Web Announcement 702]

Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2013 Provider Newsletter [Read]

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

Web AnnouncementsView All

Web Announcement 723

Annual Rate Increases for Rural Health Clinics (RHC) Provider Type 17 Specialty 180

Annual rate increases became effective October 1, 2013, for Rural Health Clinics (RHC) under Provider Type (PT) 17, Specialty 180. The rate increases apply to procedure code T1015 for the all-inclusive Prospective Payment System (PPS) medical encounter visit. Claims submitted with procedure code T1015 for dates of service on or after October 1, 2013, that were affected by the rate change will be automatically reprocessed. The results of any reprocessed claims will appear on a future remittance advice.

Web Announcement 722

Frequently Asked Questions (FAQs) Regarding Enrollment Requirement for Ordering, Prescribing and Referring Providers

A Frequently Asked Questions (FAQ) reference has been created to assist providers with the details regarding the implementation of the requirement for ordering, prescribing and referring providers to enroll in Nevada Medicaid.

The FAQs are available at the following link Ordering, Prescribing and Referring Provider Enrollment Frequently Asked Questions and are also posted on the Provider Enrollment and Pharmacy Announcements webpages at www.medicaid.nv.gov.

Web Announcement 721

Report Contact and Address Changes on Form FA-33

Providers are required to ensure that their current contact information and physical address are on file with HP Enterprise Services (HPES). Current information assists the HPES Provider Services Field Representatives in contacting the correct person on your staff when needed.

Changes to enrollment information after you enroll (except changes in business ownership) must be updated via form FA-33 within five (5) business days of the change. Business ownership changes must be reported within five (5) business days by resubmitting a complete, new set of enrollment documents and a copy of the purchase agreement.

FA-33 – Provider Information Change Form – is available on the Provider Enrollment webpage and the Provider Forms webpage at www.medicaid.nv.gov. The form can be faxed to (775) 335-8593 or mailed to HP Enterprise Services, Provider Enrollment, P.O. Box 30042, Reno NV 89520-3042.

Web Announcement 720

Updated Billing Instructions for Fetal Monitoring for Twin Gestations

This web announcement supersedes Web Announcement 311. In the case of a twin gestation, bill the appropriate fetal monitoring CPT code with one unit without a modifier and bill the subsequent unit on the next claim line with the appropriate modifier(s).

If the fetal monitoring test is performed at the hospital (using the hospital’s equipment), bill the appropriate CPT code with one unit with the appropriate modifier and bill the subsequent unit on the next claim line with the appropriate modifier(s).

Web Announcement 719

Provider Services Field Representative Team Territories Updated

The HP Enterprise Services (HPES) Provider Services Field Representatives are available to assist providers one-on-one with your Nevada Medicaid issues. The Field Representatives are assigned to providers based upon the zip code of your servicing National Provider Identifier (NPI) or Atypical Provider Identifier (API), or your provider type. The assignments have recently been restructured to provide more focused assistance and improve the overall experience. Please see the attached updated “Provider Services Field Representative Team Territories” to determine which Field Representative is assigned to you.

Providers may contact their assigned field representative by telephone or email (NevadaProviderTraining@hp.com) with inquiries. On-site visits at your Nevada professional place of business and virtual room sessions can also be scheduled by contacting your field representative. Requests for on-site visits should be made at least two weeks in advance. Please allow a minimum of 48 hours for telephone calls and emails to be returned. In addition, the Customer Service Call Center and scheduled training courses remain available to you and your staff members.

Field Representatives are available to you assist you with a wide variety of areas and topics including:

  • Complex claim inquiries (for general claim questions please contact the Customer Service Call Center at (877) 638-3472)
  • Submitting a claim for special handling
  • Submitting a claim appeal
  • Correct completion of claim forms
  • Navigating the Provider Web Portal
  • Use of the automated Audio Response System (ARS)
  • Submitting claims electronically via Allscripts-Payerpath
  • Provider enrollment and re-enrollment
  • Understanding recipient eligibility

Field Representatives are not able to assist with coding claims or clinical information.

Web Announcement 718

URGENT: Pharmacy Claims Payments to be Delayed One Week

Point of Sale (POS) pharmacy claims submitted the week of March 31, 2014, did not process due to a system issue. No payment will be issued to pharmacy providers on April 11, 2014. Two weeks of payments will be submitted with the remittance advice dated April 18, 2014.

Web Announcement 717

Launch Date Postponed for Nevada’s Health Care Guidance Program

The Division of Health Care Financing and Policy (DHCFP) has announced the postponement of the new Care Management Organization (CMO), also known as the Health Care Guidance Program. Although the original start date of April 1, 2014, has been postponed, the DHCFP hopes to implement this type of care management program within the next few months.

The program is designed to help improve health outcomes for Medicaid’s sickest Fee-for-Service recipients by offering additional support to recipients and providers. The program will include the coordination of transitional care, follow-up appointments, support services, preventive health and use of health information technology. Future web announcements on this website (www.medicaid.nv.gov) will provide additional information regarding the implementation of this program.

Web Announcement 716

Attention Provider Types 20, 28, 32, 33 and 43 Regarding Claims with Modifiers

The following modifiers have been updated in the Medicaid Management Information System (MMIS): EA, EB, EC, ED, EE, FB, FC, GD, GR, J1, J2, J3, JA, JB, KG, KU, KV, KW, KY, M2, P2, P3, P4, P5, P6, Q0 and Q1.

Claims submitted by provider types 20, 28, 32, 33 and 43 with the modifiers listed above that incorrectly denied for edit code 0041 (invalid procedure modifier) have been reprocessed. The adjudication of the reprocessed claims appears on remittance advices dated March 28, 2014.

Web Announcement 715

Quantity Limit for Promethazine with Codeine Cough Syrup

Following the recommendation of the Nevada Medicaid Drug Utilization Review Board, effective May 8, 2014, Nevada Medicaid and Nevada Check Up will limit the amount of promethazine with codeine cough syrup to 120 ML per fill and no more than three (3) fills per year. For 30 days prior to the effective date, beginning April 8, 2014, the pharmacy will receive a claim response on the paid claim with a message for recipients who have claims exceeding the quantity limit. Beginning May 8, 2014, claims that exceed the quantity limit will deny.

Web Announcement 714

April, May and June 2014 Provider Training Reminder

The HP Enterprise Services (HPES) Provider Services Field Representatives will conduct several workshops for providers in the months of April, May and June.

  • Introduction to Becoming a Nevada Medicaid Provider is offered for those interested in understanding what the Medicaid Program in Nevada entails and will focus on information, applications, public websites and general information. This course is for persons not already enrolled with Nevada Medicaid.
  • Foundations: Provider Program Basics is designed for providers new to Nevada Medicaid and Nevada Check Up, and explains the tools available to easily find claim or payment status and recipient eligibility. The second half of this workshop is dedicated to reviewing Prior Authorization Submission and will focus on how to create and manage prior authorizations, view completed prior authorizations, and find resource and contact information.
  • Claim Form Training workshops will introduce the Nevada Medicaid paper form submission guidelines and are tailored to the completion of the specific form type used for your provider type. In addition, this workshop will review the Appeals and Special Batching processes and will conclude with a step-by-step review of Allscripts PayerPath electronic claim submission tailored to the completion of the specific form type used for your provider type
  • ICD-10 Overview is a workshop that explains what ICD-10 is, when it will be required and where to find future updates.
  • Program Integrity will provide information about the three distinct programs DHCFP has to assist in ensuring the fiscal integrity of the programs it administers.

Notes:

  • All courses are non-clinical in nature.
  • Sessions that have a morning time and afternoon time are identical; they are not part 1 and part 2.*

Please review the dates, times and topics below and register by using the 2014 Provider Training Registration Form (FA-41). All times indicated are Pacific Time (PT). For questions, contact the HPES Training Department at NevadaProviderTraining@hp.com or (877) 638‐3472, option 2, then option 0, then option 4.

Virtual Room (Access details will be returned to you in an email 3 days prior to the session)
Date Time Topic
April 16 10:00 to 11:00 a.m. Introduction to Becoming a Nevada Medicaid Provider
April 21 9:00 to 10:30 a.m. Foundations: Provider Program Basics
April 25 10:00 to 11:30 a.m. CMS-1500 Claim Form Instructions; Appeals and Special Batching; and PayerPath processing
May 14 9:00 to 10:30 a.m. UB-04 Claim Form Instructions; Appeals and Special Batching; and PayerPath processing
June 12 11:00 a.m. to noon ICD-10 Overview
June 17 1:00 to 2:30 p.m. Foundations: Provider Program Basics
June 19 1:00 to 2:30 p.m. CMS-1500 Claim Form Instructions; Appeals and Special Batching; and PayerPath processing
June 25 10:00 to 11:30 a.m. Program Integrity
Las Vegas Grant Sawyer Building: 555 East Washington Ave., Las Vegas
May 23 10:00 to 11:30 a.m. *Foundations: Provider Program Basics (session 1)
May 23 1:00 to 2:30 p.m. *Foundations: Provider Program Basics (session 2)
May 29 10:00 to 11:30 a.m. *CMS-1500 Claim Form Instructions; Appeals and Special Batching; and PayerPath processing (session 1)
May 29 1:00 to 2:30 p.m. *CMS-1500 Claim Form Instructions; Appeals and Special Batching; and PayerPath processing (session 2)
Reno HPES Presentation Center: 9850 Double R Blvd., Reno
April 16 10:00 to 11:00 a.m. Introduction to Becoming a Nevada Medicaid Provider


Web Announcement 713

CMS-1500 Claim Form Dual-Use Period Extended: New CMS-1500 (02-12) Must Be Used Effective May 3, 2014

Effective with claims received at HP Enterprise Services (HPES) on or after May 3, 2014, the new CMS-1500 (02-12) claim form must be used. The dual-use period of version 02-12 and version 08/05 has been extended to end on May 2, 2014. Effective May 3, 2014, the CMS-1500 (version 08/05) will be returned to providers.

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

  • In Field 21, enter up to twelve (12) ICD-9 codes in the spaces indicated A through L. Please enter the codes across each line, not down.
  • In Field 24E, the Diagnosis pointers must be alpha characters. They are no longer numeric values. If you enter multiple codes in Field 21, then in Field 24E use a dash between the first and last letters, i.e., A-D, instead of ABCD. Please note: This is a claim form field in which dashes are acceptable.
  • In Field 30, the space is labeled as reserved for NUCC use, but the Balance Due is required. If Medicaid is primary coverage, enter the amount shown in Field 28. If the recipient has Third Party Liability (TPL) (including Medicare), enter the recipient’s legal obligation to pay. Do not include write-off, contractual adjustment or behavioral health reduction amounts.
  • Electronic billers: Please refer to the Transaction 837P – Professional Health Care Claim and Encounter Companion Guide for billing instructions. The Companion Guides are available on the Electronic Claims/EDI webpage.


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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