URGENT REMINDER: Dual-Use Periods Are Ending for ADA and CMS-1500 Claim Forms; New Forms Must Be Used [Web Announcement 729]
Attention Pharmacies: 30-Day Override Period Point-of-Sale Processing Instructions for Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners [Web Announcement 825]
Nevada Medicaid and Nevada Check Up News (Third Quarter 2014 Provider Newsletter) [Read]
Provider Web Portal Quick Reference Guide (Updated April 16, 2012)
Web Announcement 827
Quantity Limit for Oral Contraceptives
Effective November 1, 2014, the quantity limit for oral contraceptives billed by a physician’s office will be increased from 5 to 28 tablets.
Web Announcement 826
URGENT INFORMATION: Provider Types Required to Include NPI of Ordering, Prescribing and Referring (OPR) Provider on Claims: 16, 17, 19, 23, 27, 29, 33, 34, 37, 43, 45, 46, 55, 63, 64 and 68
URGENT INFORMATION: 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.
The NPI of the OPR provider is mandatory for certain provider types because the services they provide are always ordered or referred. 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.
Web Announcement 825
Attention Pharmacies: 30-Day Override Period Point-of-Sale Processing Instructions for Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners
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.
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, 2014, when the pharmacist may choose to override a denied claim for OPR. Pharmacies will receive the following message to place the override:
PRESCRIBER NOT ENROLLED IN NV MEDICAID,
ONE-TIME OVERRIDE PERMITTED PER Rx
SUBMIT PA TYPE '01',PA '22222222222'
To enter the override, submit ‘01’ in the Prior Authorization Type Code (461-EU) and ‘22222222222’ in the Prior Authorization Number Submitted (462-EV) fields. One override per prescription is permitted.
After the 30-day override period, the pharmacy will not be able to override a denied claim due to the OPR hard edit placed in the Point-of-Sale system. The pharmacy is encouraged to inform recipients and physicians that future prescriptions will not be able to be filled unless the physician is enrolled in Nevada Medicaid.
Web Announcement 824
National Drug Code (NDC) Training Scheduled in November for Providers Who Bill for Physician-Administered Drugs
The HP Enterprise Services (HPES) Provider Services Field Representatives will conduct provider training sessions in November regarding National Drug Code (NDC) billing. The workshops will define fee-for-service billing requirements and resources for providers who bill for physician-administered drugs. HPES Pharmacy Benefits Management staff will be present at this training.
Limited seating is available. Please register soon for one of the sessions listed below by using the 2014 Provider Training Registration Form (FA-41).
For questions, contact the HPES Training Department at NevadaProviderTraining@hp.com.
- RENO: Wednesday, November 5, 2014, 9 to 11 a.m. Pacific Time, at the Reno HPES Presentation Center, 9850 Double R Blvd.
- LAS VEGAS: Wednesday, November 12, 2014, 3 to 5 p.m. Pacific Time, at the Grant Sawyer Building, 555 East Washington Ave.
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:
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: firstname.lastname@example.org. 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.
||7 to 8 a.m.
||7 to 8 a.m.
||3 to 4 p.m.
||7 to 8 a.m.
||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.