• 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]

Notification

On October 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 Monday, October 27.

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 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:

11004 11005 11006 11008 11057 11200 11301
11302 11303 11306 11307 11308 11310 11311
11312 11313 11400 11401 11402 11403 11404
11406 11420 11421 11422 11423 11424 11426
11440 11441 11442 11443 11444 11450 11451
11960 11970 11971 17004 17111 19370 19371

 

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: 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 Tuesday November 4 7 to 8 a.m.
UB Thursday November 6 7 to 8 a.m.
ADA Wednesday November 12 3 to 4 p.m.
CMS-1500 Thursday November 13 7 to 8 a.m.
CMS-1500 Thursday November 20 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.

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.

 


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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