Web Announcement 774
Ordering, Prescribing and Referring Provider Enrollment Requirement to be Implemented August 18, 2014
Effective August 18, 2014, the Division of Health Care Financing and Policy is implementing the requirement for Ordering, Prescribing and Referring (OPR) providers to be enrolled in Nevada Medicaid.
Effective with claims received by HP Enterprise Services (HPES) on or after October 15, 2014, the National Provider Identifier (NPI) of the Ordering, Prescribing or Referring (OPR) provider must be included on all Nevada Medicaid/Nevada Check Up claims or those claims will be denied.
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.
Again, if the NPI of the ordering, prescribing or referring provider noted on the claim is not enrolled in the Nevada Medicaid program, for claims processed on or after October 15, 2014, the claim will not be paid.
Please note: The NPI on the OPR Enrollment Application must be for an individual physician or non-physician practitioner (not an organizational NPI).
Web Announcement 773
Attention Provider Types 30 and 83: Functional Assessment Service Plan Tool Updates Effective August 1, 2014
The Nevada Medicaid Personal Care Services (PCS) Functional Assessment Service Plan (FASP) tool and instructions have been updated and will go into effect August 1, 2014. PCS provider agencies and intermediary service organizations (provider types 30 and 83) please note the following details:
1. The FASP is now one document. The PCS provider agency will receive one complete document.
2. The PCS provider agency must provide a copy of the FASP to the recipient.
a. Documentation must be maintained showing that the recipient has received a copy of their FASP.
3. Your new FASP will indicate the number of days per week and the recommended number of visits per day. This information should be taken into consideration when determining any flexibility of services and your plan of care.
a. Days per week and/or hours per day cannot be bundled, and must meet the medical necessity intended on the FASP.
b. Documentation must be maintained showing that the recipient has agreed upon any flexibility of services.
c. Documentation should be maintained that the PCS provider has discussed with the recipient how their needs will be met based on the covered tasks indicated on the FASP.
4. The new FASP is available at this link: Functional Assessment NMO-7073. Please note the following:
a. Box 16 will provide the actual breakdown of time by each task. If the task shows zeros, this task is not an authorized task on your FASP.
b. Box 17 should be reviewed for any additional time that has been authorized due to special circumstances. If this is used, it will include the time from Box 16, as well as any additional authorized time and the specific task for which it was authorized.
c. Box 18 will provide you with the final total authorized hours, as well as the total number of days per week, and the suggested number of visits per day.
d. NOTE: Although you are receiving specific amount of time per task, you are still able to use the flexibility of services policy to best meet the needs of the recipient.
5. The courtesy authorization page will no longer be faxed with the FASP. Agencies must utilize the Electronic Verification System (EVS) to obtain their prior authorization number and to view authorized units and authorized dates of service. Verification of eligibility remains the provider’s responsibility. To access EVS, visit the Nevada Medicaid website at www.medicaid.nv.gov. Select the “EVS” tab to review the User Manual and to register or login to EVS. For assistance with obtaining a secured login or accessing EVS, contact the HP Enterprise Services Field Representatives at NevadaProviderTraining@hp.com.
6. For a variety of reasons assessments are sometimes delayed; the provider agency should verify a recipient’s prior authorization utilizing EVS before calling HP Enterprise Services (HPES) to check the status. Services are never ended or reduced without providing advanced notice, unless the recipient has been admitted to a facility, group home or other entity that includes personal care services.
Web Announcement 772
Provider Types 10 and 46: Use HCPCS Code G0260 for Sacroiliac Joint Injection in ASC Setting
Sacroiliac Joint Injection procedure performed by provider types 10 (Outpatient Surgery, Hospital Based) and 46 (Ambulatory Surgical Centers) in an Ambulatory Surgery Center (ASC) setting must be billed using HCPCS code G0260. CPT code 27096 is not appropriate for use in an ASC setting.
Web Announcement 771
340B Drug Discount Program
The 340B Drug Discount Program is a federal program that requires drug manufacturers to provide covered outpatient drugs to certain eligible 340B-enrolled entities at significantly reduced prices. For these 340B entities, the Division of Health Care Financing and Policy (DHCFP) is prohibited from claiming drug rebates as this would subject the drug manufacturers to duplicative discounts. All drug claims submitted by a 340B pharmacy to DHCFP are excluded from the drug rebate collection process.
DHCFP utilizes the Health Resources and Services Administration’s (HRSA’s) Medicaid Exclusion File to identify 340B providers. Pharmacies registered as a 340B pharmacy must bill with their actual acquisition cost. If a pharmacy decides to bill DHCFP as a 340B pharmacy, ALL outpatient drugs billed to DHCFP must be billed with the pharmacy’s actual acquisition cost. This applies to Medicaid Fee-for-Service and Medicaid Managed Care claims.
Please refer to: http://www.hrsa.gov/opa/ for more details.
Web Announcement 770
PayerPath Claim Submission Training
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: email@example.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.
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*All times indicated are Pacific Time (PT).
Web Announcement 769
Pediatric Enhancement-Surgical Services Claim Reprocessing Delayed
Update to Web Announcement 751 (published June 11, 2014): Some rates for Pediatric Enhancement-Surgical Services codes (for provider types (PT) 20 Physicians, PT 24 Certified Nurse Practitioner and PT 77 Physician Assistant) have not been updated in the Medicaid Management Information System (MMIS), which will cause a delay in reprocessing claims with dates of service on or after July 1, 2013, and processed before March 16, 2014. Future web announcements on this website (www.medicaid.nv.gov) will provide updates.
The claims for Anesthesia (PT 20 Physicians and PT 72 Nurse Anesthetist) and Obstetrics (PT 20 Physicians) are not impacted and will be automatically reprocessed. As providers were notified in Web Announcement 751, the results of the reprocessed claims will be reflected on a future remittance advice.
Web Announcement 768
Attention Provider Type 39: Regarding Adult Day Health Care (ADHC) Authorization Notices
Effective July 8, 2014, HP Enterprise Services (HPES) will no longer fax a courtesy authorization notice to provider type 39 (Adult Day Health Care). You can check your authorization status by using the Electronic Verification System (EVS).
To access EVS, visit the Nevada Medicaid website at www.medicaid.nv.gov. Select the “EVS” tab to review the User Manual and to register or login to EVS. EVS is available 24 hours a day, 7 days a week, except during maintenance periods. For assistance with obtaining a secured login or accessing EVS, contact the HPES Field Representatives at NevadaProviderTraining@hp.com.