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]
Attention Applied Behavior Analysis Providers: Training Sessions Scheduled for Providers Interested in Enrolling as a Nevada Medicaid ABA Provider [Web Announcement 916]
Nevada Medicaid and Nevada Check Up News (First Quarter 2015 Provider Newsletter) [Read]
Provider Web Portal Quick Reference Guide (Updated April 16, 2012)
Web Announcement 922
Provider Type 38: Submit Claims for Waiver Services Electronically
Provider Type 38 (Waiver for Individuals with Intellectual Disabilities and Related Conditions) providers submitting claims for codes T2014, T2017 (direct service or night services), T2018, T2020 and T2038 for recipients with Third Party Liability (TPL) no longer need to submit the claims on paper for manual processing. Please submit these claims electronically. For electronic billing instructions, please refer to Transaction 837P – Professional Health Care Claim EDI Companion Guide.
Web Announcement 921
Upcoming Updates to Nevada Provider Enrollment
HP Enterprise Services (HPES), in partnership with the Nevada Division of Health Care Financing and Policy (DHCFP), is currently working on a web-based Provider Enrollment Portal to automate provider enrollment. The Provider Enrollment Portal will allow providers to complete new enrollment, re-enrollment and provider changes using a web-based application. Future web announcements on this website will notify providers of the implementation date for the Provider Enrollment Portal.
Web Announcement 920
Vaccine Billing Clarification
The Division of Health Care Financing and Policy (DHCFP) is collaborating with the Division of Public and Behavioral Health on tracking vaccines for Nevada Check Up kids under the Nevada State Immunization Program (NSIP). A memo, dated May 4, 2015, was recently sent out to providers from the NSIP. This web announcement serves to provide clarification of the memo.
Currently, providers bill for the vaccine administration with a Current Procedural Terminology (CPT) code and the vaccine serum using a CPT or National Drug Code (NDC) with either a zero rate or a modifier SL (state supplied vaccine).
After July 1, 2015, providers who service regular Medicaid and Nevada Check Up recipients may continue to bill for the vaccine administration using the most appropriate CPT code. All vaccine serum will now require NDCs for Nevada Medicaid or Nevada Check Up. Providers must continue to use a zero rate for reimbursement for Vaccines for Children (VFC) vaccines, or the SL modifier. Even with a zero rate on the claim, quantity and days supply must be included on the claim or the claim will deny.
Providers have been inquiring about recognizing the difference between Nevada Check Up and regular Medicaid in the Electronic Verification System (EVS). The type of eligibility will not affect the new way of billing for vaccines, as both Nevada Check Up and regular Medicaid will be billed the same way. For information purposes, in the EVS, regular Medicaid is recognized with a Roman numeral XIX (19) and Nevada Check Up is recognized with a Roman numeral XXI (21).
For questions, please contact Marti Coté at (775) 684-3748 or email@example.com
Web Announcement 919
Security Settings and Password Requirements Enhanced in the Provider Web Portal
On May 18, 2015, security modifications were made to the Provider Web Portal to enhance security settings and update password requirements. The new password requirements are listed on the “Change Password Assistance” page on the Provider Web Portal. Please see the full Web Announcement 919 for details and screenshots explaining the modifications.
Web Announcement 918
Payerpath Claim Submission Training for June 2015
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.
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: 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.
||7 to 8 a.m.
||7 to 8 a.m.
||4 to 5 p.m.
*All times indicated are Pacific Time (PT).
Web Announcement 917
Attention Provider Types 14 and 26: Prior Authorization Requirements for CPT Codes 96150 and 96151
Health and behavior assessment (CPT code 96150) and re-assessment (CPT code 96151), 15-minute units, need prior authorization only when they exceed 2 (for adults) or 4 (for adolescents) sessions per calendar year. Claims for CPT codes 96150 and 96151 submitted by provider types 14 and 26 with dates of service on or after March 1, 2013, and with process dates on or before December 15, 2014, that denied inappropriately with edit code 0155 (Procedure requires authorization) will be automatically reprocessed. The results of the reprocessed claims will be reflected on remittance advices dated May 22, 2015.
Web Announcement 916
Attention Applied Behavior Analysis Providers: Training Sessions Scheduled for Providers Interested in Enrolling as a Nevada Medicaid ABA Provider
Training sessions have been scheduled in June 2015 in Reno and Las Vegas for providers interested in enrolling in the Nevada Medicaid Program as Applied Behavior Analysis (ABA) providers. The training sessions will include a Nevada Medicaid Overview and Provider Enrollment training with HP Enterprise Services (HPES), Health Plan of Nevada (HPN) and Amerigroup.
Providers qualified to enroll as ABA providers are Licensed and Board Certified Behavior Analysts (BCBA), Licensed Psychologists, Licensed and Board Certified Assistant Behavior Analysts (BCaBA), Certified Autism Behavior Interventionists (CABI) and Registered Behavior Technicians (RBT).
To enhance access to the training sessions, there will be a morning session and afternoon session offered in Reno and a morning session and afternoon session offered in Las Vegas. The sessions will all include the same information, so it is only necessary to attend one session.
- June 5, 2015: The Reno sessions will be held at the University of Nevada, Reno, College of Education, William J. Raggio Building, Room 2030, 2nd Floor.
- June 26, 2015: The Las Vegas sessions will be held at the Brady Industries building, 7055 Lindell Road, Las Vegas.
In both locations, registration for the morning sessions will begin at 8 a.m., and the sessions will be from 8:30 a.m. to noon. Registration for the afternoon sessions will begin at 1 p.m., and the sessions will be from 1:30 p.m. to 5 p.m.
Please RSVP to attend one of the sessions by sending an email to Nevadaprovidertraining@hp.com with the subject line: ABA Training – Reno morning (or afternoon) or ABA Training - Las Vegas morning (or afternoon) depending on the session you would like to attend. Please also include the names of additional individuals who will be attending, the National Provider Identifier (NPI) for each, if applicable, and valid email addresses and telephone numbers for each. Prior to the training, a confirmation email will be sent to you as a reminder and parking information will be included at that time.
If you have questions concerning the training sessions, please contact: Nevadaprovidertraining@hp.com
Web Announcement 915
Attention Provider Types 20, 25 and 41 Regarding HCPCS Code V2744 (Tint Photo Chromatic Lens/es)
Effective on claims with dates of service on or after May 1, 2015, provider types 20, 25 and 41 may bill HCPCS code V2744 (Tint, Photo Chromatic Lens/es). Medicaid Services Manual Chapter 1100 allows for tinted lenses in eyeglasses if medically necessary.