• 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]

Attention Pharmacies: Update Regarding Implementation of Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners [Web Announcement 799]

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 805

New Speech Evaluation Codes Billable by Provider Type 60 (School Based); Denied Claims for the New Codes Reprocessed

Effective with dates of service on and after January 1, 2014, the following speech evaluation codes are billable by provider type (PT) 60 (School Based): CPT codes 92521, 92522, 92523 and 92524. Modifier GN is required for billing.

CPT code 92506 was terminated effective December 31, 2013, and is no longer a Nevada Medicaid covered code for PT 60.

Claims submitted by PT 60 for CPT codes 92521, 92522, 09523 and 92524 with dates of service on or after January 1, 2014, and processed before May 27, 2014, that denied have been automatically reprocessed. The adjudication of the reprocessed claims appeared on remittance advices dated August 15, 2014.

Web Announcement 804

Provider Type 14: Review Supervision Standards for Medical Supervision

Provider type 14 (Behavioral Health Outpatient Treatment) providers are referred to Medicaid Services Manual (MSM) Chapter 400 Section 403.2A for review of the Supervision Standards for Medical Supervision. Medical supervision includes ongoing evaluation and monitoring of the quality and effectiveness of the services provided. Please also note that medical supervisors must operate within the scope of their licensure and expertise and attest to having at least two years experience in a mental health setting with competency to oversee and evaluate a comprehensive mental health treatment program. Verification is provided upon enrollment in Nevada Medicaid as a medical supervisor.

Further, medical supervision for the Behavioral Health Community Networks (BHCN) must be updated within five (5) days of any changes being made by completing the Provider Information Change form (FA-33) per the Medicaid Services Manual, Chapter 100.

Web Announcement 803

Reminders for Checking Eligibility on the Provider Web Portal

The following reminders will assist providers when checking recipient eligibility on the Provider Web Portal.

  • When checking eligibility, enter the recipient information and click “Submit.” After clicking the “Submit” button, the eligibility displays in the Eligibility Verification Information section in the lower part of the Eligibility Verification Request screen. You can then click on the coverage and other insurance links in the Eligibility Verification Information section to view additional information.

  • Web Announcement 803

  • If you need to check eligibility for a second recipient, navigate back to the Eligibility Verification Request screen if you clicked on the coverage or other insurance links. Click the “Reset” button to clear the previously submitted recipient information. Then, complete the recipient information fields and click the “Submit” button to display the eligibility information for the new recipient.

Web Announcement 802

Streamlined Claim Appeal Request Process Implemented

A streamlined process has been implemented for providers to submit claim appeals. A provider claim appeal request now requires less information and fewer documents from the provider, and claim appeals may be submitted via email.

Effective immediately, the required documents providers must submit to request a claim appeal are:

  • A letter addressing the specific reason for the appeal, which includes the provider name and National Provider Identifier (NPI) or Atypical Provider Identifier (API), the ICN of the claim, and the name and telephone number of the person to be contacted regarding the appeal. Providers may use form FA-90 Formal Claim Appeal Request as the cover letter.
  • Documentation to thoroughly support the appeal request.
  • A completed, original signed paper claim that may be used for processing should the appeal be approved.

Claim appeals may be submitted via mail to HP Enterprise Services, Attn.: Claim Appeals, P.O. Box 30042, Reno NV 89520-3042 or via email to ProviderClaimAppeals@hp.com. To submit via email, scan the letter or form FA-90, all supporting documents, and the completed signed original claim, and attach all items to one email. Please send the documents using secure email and write “Claim Appeal” in the subject line. Please note: If the claim appeal is submitted via email, all future correspondence regarding the appeal will be done via email.

Web Announcement 801

Save the Date: 2014 Annual Medicaid Conference Scheduled for October

Nevada Medicaid and Nevada Check Up providers are urged to attend 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

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.

Last year’s event, which focused on the effects of health care reform and Medicaid Expansion on Nevada Medicaid and Nevada Check Up, was well-attended by providers.

The 2014 Conference will include updates regarding Long Term Care Services, Presumptive Eligibility, Managed Care, the new Health Care Guidance Program, Electronic Health Records, Clinical Policy Updates and Medicaid Fraud.

Register soon for this year’s Medicaid Conference at the following website: http://starcite.smarteventscloud.com/hp/Annual_Medicaid_Conference_2014.

Web Announcement 800

Ordering, Prescribing and Referring Providers Not Allowed to Register for Access to Provider Web Portal

Providers who are enrolled in Nevada Medicaid as an Ordering, Prescribing or Referring (OPR) provider may not register for access to the Provider Web Portal. The following error message will be displayed if an OPR provider tries to register for access to the Provider Web Portal.

-1001: Personal identity information not recognized or provider is inactive or OPR provider.

Web Announcement 800

Web Announcement 799

Attention Pharmacies: Update Regarding Implementation of Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners

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. Compliance with this requirement necessitates future changes to Nevada Medicaid claims and provider enrollment processes. The Division of Health Care Financing and Policy (DHCFP) will implement this new requirement on October 29, 2014

How will this affect you?

The practitioner writing a prescription for a Medicaid Fee-for-Service recipient needs to be enrolled as a full Medicaid service provider or an OPR-only provider by October 29, 2014.

To comply with these provisions, Nevada Medicaid, with the implementation of the OPR claims adjudication process, will verify both the presence of a valid practitioner National Provider Identifier (NPI) and the practitioner’s enrollment in Nevada Medicaid as either a full Medicaid service provider or an OPR-only provider. Pharmacy claims will post a soft edit 45 days prior to October 29, 2014, informing the billing provider if the NPI for the prescriber is not present or if the prescriber is not enrolled in Nevada Medicaid. Effective on and after October 29, 2014, if the prescriber does not have prescriptive authority or if the prescriber is not enrolled as a full Nevada Medicaid service provider or an OPR-only provider, then the edit will result in a claim denial. There will be a 30-day override period starting October 29, when the pharmacist may choose to override a denied claim for OPR. If a claim hits the soft edit, pharmacies should notify the recipient to contact their prescriber because after implementation their claims will deny.

Regarding the use of NPIs: Every prescriber must include their personal NPI on each prescription. Every pharmacy must accurately submit this prescriber NPI with each prescription claim. If a provider intentionally submits a claim with a prescriber NPI which they know to be inaccurate, they are committing a fraudulent act, and may be subject to administrative, civil and/or criminal actions.

For more information about the changes to billing and the new OPR provider enrollment category, call the Catamaran Technical Call Center at (866) 244-8554.

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.

The Nevada Division of Health Care Financing adheres to all applicable privacy policies and standards, including HIPAA rules and regulations, regarding protected health information. Click here to see the State of Nevada Online Privacy Policy

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