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Urgent Notification

ICD-10 Codes Must Be Used on Claims with Dates of Service on or after October 1, 2015. Are You Ready?

Urgent Notification

URGENT: Claim Form Field Instructions for Entering NPI of Ordering, Prescribing or Referring Provider[Web Announcement 830]

Latest News

URGENT: Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Web Announcement 850]

Nevada Medicaid and Nevada Check Up News (Third Quarter 2015 Provider Newsletter) [Read]

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

Web AnnouncementsView All

Web Announcement 1020

Attention Provider Type 17 Specialty 174: CPT Code 58110 May Be Billed

Effective with claims with dates of service on or after January 1, 2015, CPT code 58110 (Endometrial sampling (biopsy) performed in conjunction with colposcopy) may be billed by provider type 17 (Special Clinic) specialty 174 (Public Health Clinic) with modifiers 22, 54, 55, 56 and 62. Prior authorization is not required. Effective December 15, 2015, these claims will no longer deny for edit codes 0148 (Rendering provider not certified to perform procedure) or 0210 (No fees found on file). Claims by PT 17 specialty 174 for CPT code 58110 submitted on or after January 1, 2015, that denied for edit codes 0148 or 0210 will be automatically reprocessed. The results of the reprocessed claims will appear on a future remittance advice.

Web Announcement 1019

Changes for Durable Medical Equipment Wheelchair Repairs

Effective December 1, 2015, the Nevada Division of Health Care Financing and Policy (DHCFP) will start using a new specialized form for wheelchair repairs to be provided with all wheelchair repair prior authorization requests. Failure to use this form after January 31, 2016, will result in wheelchair repair denials.

There will be NO changes to policy located within Medicaid Services Manual (MSM) Chapter 1300, but there will be a change requiring this new form when requesting wheelchair repairs.

The new form FA-1D (Wheelchair Repair Form) will be located on the Provider Forms webpage (https://www.medicaid.nv.gov/providers/forms/forms.aspx under prior Authorization Forms) by December 1, 2015, for use, with the required effective date of January 1, 2016.

Web Announcement 1018

Attention Provider Types 11 and 46: Prior Authorization and Billing Requirements for Cornea Procurement; Maximum All-Inclusive Procurement Rate Established

Nevada Medicaid has established a maximum reimbursement rate for provider types (PT) 11 (Inpatient Surgery-Hospital Based) and 46 (Free-Standing Ambulatory Surgical Centers) for Cornea Procurement. The established rate is for Cornea Procurement only; all other services associated with the transplant will continue to be reimbursed under current methodologies. Cornea Procurement is reimbursed the lower of 1) billed charges or 2) the maximum all-inclusive facility procurement rate set forth below.

To receive the reimbursement rate for Cornea Procurement, the facility is required to obtain a prior authorization (PA) from Medicaid’s QIO-like vendor (Hewlett Packard Enterprise) for the Cornea Transplant, and a letter of agreement (LOA) from the Division of Health Care Financing and Policy (DHCFP). The LOA will be issued until the Nevada State Plan is amended to add Cornea Procurement to the Hospital and ASC sections. The PA will identify the CPT code authorized for the Cornea Transplant. The LOA for the Cornea Procurement will be issued by DHCFP, and will identify the following: provider name and National Provider Identifier (NPI); recipient name and Medicaid identification number; and the established reimbursement rate for the procurement. Medicaid will not provide an LOA for the Cornea Procurement until/unless a PA for the Cornea Transplant has been issued to the facility by Hewlett Packard Enterprise.

Service All-inclusive facility procurement rate
Cornea Procurement $2,500.00

Web Announcement 1017

Notice for Provider Type 63: Residential Treatment Center (RTC) AKA Psychiatric Residential Treatment Facility (PRTF) Regarding Discharge Medications

Per Medicaid Services Manual Chapter 400, Section 403.8(B)(7): Provider Responsibilities include that RTC’s ensure upon discharge that the legal representative of the Medicaid eligible recipient be given a supply or access to current prescribed medications. Therefore when discharging a Nevada Medicaid recipient please ensure that prescriptions are written by an enrolled Nevada Medicaid provider and that an adequate supply of medications is dispensed to the recipient or legal representative or included in the written discharge prescriptions, based on the discharge appointment planning and the recipient’s access to outpatient care. It is important for the recipient to maintain compliance with their current prescribed medications, and to assist in the continuity of care from RTC to outpatient care.

Reminder: To assist in the recipient’s access to outpatient care, if the recipient is discharged before the last authorized date, the provider is to submit, by fax, the Prior Authorization Data Correction Form (FA-29) with the corrected discharge date.

Consistent with implementation of the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) requires all Ordering, Prescribing and Referring (OPR) providers to enroll in the Medicaid program in order to prescribe even if they do not submit claims to Medicaid. Please see Web Announcement 826: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_826_20141030.pdf.

A link to the OPR application on the Provider Enrollment webpage is provided below:

If you have any questions about policy requirements, please contact Hilary Jones, R.N., HCC III at (775) 684-3753.

Web Announcement 1016

Remittance Advice Issue Corrected

A system issue was identified that was preventing claims from appearing on remittance advices for providers that were not active for the date of service on the claim. Effective November 16, 2015, the system has been corrected and providers will start seeing these claims on a remittance advice.

Web Announcement 1015

Payerpath Claim Submission Training for December 2015

The Hewlett Packard Enterprise 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.

To participate in the training, please 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@hpe.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 December 1 7 to 8 a.m.
ADA Wednesday December 2 7 to 8 a.m.
CMS-1500 Tuesday December 8 7 to 8 a.m.
UB Wednesday December 9 7 to 8 a.m.
CMS-1500 Wednesday December 16 7 to 8 a.m.

*All times indicated are Pacific Time (PT).

Web Announcement 1014

Attention Provider Types 12, 20, 24, 33 and 77: Rates Established for Codes with Zero Rates

Effective with claims with dates of service on or after December 1, 2015, rates have been established for codes that previously had a zero rate and were inappropriately paying 62 percent of billed charges.

Affected procedure codes and affected provider types are shown below:

Procedure Code Provider Type(s)
43206 20, 24, 77
43252 20, 24, 77
77371 12
78072 20
88375 20, 24
97607 12, 20, 24, 77
97608 12, 20, 24, 77
97610 20, 24, 77
A4336 33
E2359 33
E2378 33
L0113 33
L3927 33
L5301 33
L8629 20, 33

Web Announcement 1013

Enhancements to Provider Web Portal Prior Authorizations

On November 16, 2015, enhancements were made to the Provider Web Portal Prior Authorization application to allow multiple medical citation reasons on a Notice of Decision (NOD). The “Prior Authorization View Authorization Response,” “View Authorization Print” and “View Denial Information” pages can now display up to five medical citation reasons per service line for a more detailed reason of decision. Please see the full Web Announcement 1013 for examples of the three pages.

Web Announcement 1012

Urgent Pharmacy Announcement: Pricing Override Allowing Brand Products to Pay at Brand Price

Nevada Medicaid and Nevada Check Up began using a NADAC based price effective November 1, 2015. See Web Announcement 982. The Preferred Drug List (PDL) dictates the use of some brand products even though there is a generic available. Effective Friday, November 6, 2015, a pricing override was placed to allow certain brand products to pay at the brand price. Pharmacies may reverse and rebill these products to reflect the updated price. Any claims not reversed and rebilled by the pharmacy will be automatically reprocessed through a reverse and rebill process by Optum. The date of the reverse and rebill is yet to be determined, but will be within the coming weeks. Thank you for your cooperation.

Web Announcement 1011

Services for Children with Autism Spectrum Disorder Update

On July 7, 2014, the Centers for Medicare & Medicaid Services (CMS) released guidance (CIB 07-07-2014) on approaches available under the federal Medicaid program for providing medically necessary diagnostic and treatment services to children with Autism Spectrum Disorder (ASD). CMS is not singling out Applied Behavior Analysis (ABA) or any other specific treatment in its directive to states, but is indicating the services must be comprehensive and include behavioral intervention.

The Nevada Division of Health Care Financing and Policy (DHCFP) is proposing coverage for ABA services for categorically needy individuals under age 21, identifying Early and Periodic Screening, Diagnostic and Treatment (EPSDT) as the coverage authority. Currently, Nevada Medicaid covers screenings under EPSDT. See Web Announcement 892 for details.

Upcoming Activities:

  • Provider enrollment and credentialing is now open. Provider enrollment checklists are online on the Provider Type 85 Applied Behavior Analysis (ABA) enrollment checklist webpage. See Web Announcements 940 and 951 for enrollment instructions.
  • Prior authorization and billing training sessions for providers will be scheduled for the fall of 2015. Please check web announcements at www.medicaid.nv.gov for details.
  • The PT 85 Billing Guideline will be posted under Billing Guidelines (by Provider Type) on the Billing Information webpage.
  • A Public Hearing was held on the Policy State Plan Amendment (SPA), Rates State Plan Amendment (SPA), and the medical coverage policy on October 19, 2015. See the DHCFP Public Notices webpage for details.
  • Policy and Rates SPA’s will be submitted for CMS approval. CMS has 90 days for comment.
  • Ongoing information regarding the medical coverage policy development for ABA services can be found on the DHCFP ABA webpage at: http://dhcfp.nv.gov/Pgms/CPT/ABA/.
  • ABA services are anticipated to be effective January 1, 2016. Any billing for services provided prior to the effective date are non-reimbursable by Nevada Medicaid.

Web Announcement 1010

Applied Behavior Analysis (ABA) Provider Training Sessions

Applied Behavior Analysis (ABA) services are anticipated to be effective January 1, 2016. Prior authorization requests may be submitted beginning December 1, 2015. Training has been scheduled to assist ABA providers (provider type 85) in being prepared to submit prior authorization requests and claims for services.

The training will review the prior authorization submission process, the ABA Billing Guide, instructions on using the CMS-1500 claim form, enrollment in Payerpath for electronic claim submission and submitting claims electronically using Payerpath.

Please review the locations, dates, times and topics below and register for the training you would like to attend by going to the provider training registration webpage:


The times indicated are Pacific Time. Training is offered in a virtual room setting or at the training site indicated below. Access details for the virtual room training will be returned to you in an email 3 days prior to the session.

Virtual Room
Day, Date
Thursday, Nov. 19 2 p.m. to 3 p.m. ABA Prior Authorization Submission Training
Friday, Nov. 20 9 a.m. to 10 a.m. ABA Prior Authorization Submission Training
Friday, Dec. 11 1 p.m. to 3 p.m. ABA Billing Guide, CMS-1500 and Payerpath Enrollment
Monday, Dec. 21 7 a.m. to 8 a.m. ABA Payerpath Claim Submission Training
Las Vegas Grant Sawyer Building: 555 East Washington Ave., Las Vegas
Wednesday, Dec. 2 9 a.m. to 11 a.m. ABA Billing Guide, CMS-1500 and Payerpath Enrollment

Web Announcement 1009

Attention Provider Types 12, 20, 45 and 81:
Form FA-100 Must Be Attached to Initial Claim for Outpatient Emergency Dialysis Services for all New Federal Emergency Services (FES) Recipients

Nevada Medicaid End Stage Renal Disease (ESRD) providers (provider types 12, 20, 45 and 81) must complete and sign Emergency Dialysis Case Certification forms to certify that a non-U.S. citizen has met the medical conditions to be eligible to receive outpatient emergency ESRD services through the Federal Emergency Services (FES) program. The Initial Emergency Dialysis Case Certification (form FA-100) must be completed and attached to the initial claim for outpatient emergency dialysis services for all new FES recipients covered under the FES program.

Please note:

  • If FA-100 has not been submitted, the claim will be denied for edit code 0450 (Non-emergency services not authorized for non-citizens).
  • Effective November 2, 2015, subsequent claims (after the initial claim) no longer require paper submission to be processed.

The Monthly Emergency Dialysis Case Certification (form FA-101) must be completed and signed at the beginning of each month and placed in the FES recipient’s file.

The forms are available on the www.medicaid.nv.gov website on the Providers Forms 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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