Web Announcement 1153
Clinical Claim Editor Updated with NCCI Quarter 2 2016 Files
The clinical claim editor in the Medicaid Management Information System (MMIS) will be updated on May 30, 2016, with the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Quarter 2 2016 files, which were effective April 1, 2016. Any claims processed on or after April 1, 2016, through May 30, 2016, that were not processed using the updated NCCI files will be automatically reprocessed. A future web announcement will notify providers when the affected claims are reprocessed.
Web Announcement 1152
Attention Provider Type 22: American Dental Association (ADA) Dental Codes D9223 and D9243 Do Not Require Prior Authorization
American Dental Association (ADA) dental codes D9223 (General anesthesia, each 15 minutes) and D9243 (IV sedation, each 15 minutes) do not require prior authorization (PA). Claims for codes D9223 and D9243 that are denying inappropriately with edit code 0155 (Procedure requires authorization) will be automatically reprocessed. You do not need to resubmit your denied claims. The claims processing system is being updated with the correct PA requirement. A future web announcement will notify providers when the PA requirement has been updated in the system and will provide details regarding the claims that will be reprocessed.
Web Announcement 1151
Urgent: Payment Delay for Certain Claims
Due to an exception in the weekly financial cycle, it is anticipated that there may be a delay in claims payment for
services provided to Nevada Medicaid and Nevada Check Up recipients. The pended claims will potentially affect
all provider types. Any affected claims will pend with edit code 0291 (Suspended for Budget Relief). Affected
claims that would normally pay on remittance advices dated May 27, 2016 will automatically be released
for adjudication on remittance advices dated June 3, 2016.
Providers are reminded that they can avoid holding for a Customer Service Call Center representative by verifying
the status of claims through the Electronic Verification System (EVS) on the Provider Web Portal or the Automated
Response System (ARS).
- EVS is accessed through 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 User Manual Chapter 3 provides step-by-step
instructions on searching and viewing claims that providers have submitted.
- ARS is accessed by telephone by calling (800) 942-6511.
If the payment delay creates a financial hardship, providers may request an advance payment by sending an email
to Hewlett Packard Enterprise at NevadaProviderTraining@hpe.com. Enter “Advance Payment Request/Financial
Hardship” in the subject line and include in the email: the amount of the advance requested; the reason for the
request; the provider’s National Provider Identifier (NPI); and the provider’s name, address and telephone number.
Web Announcement 1150
Payerpath Claim Submission Training for June 2016
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: 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.
||7 to 8 a.m.
*All times indicated are Pacific Time (PT).
Web Announcement 1149
New Prior Authorization Forms Available for Psychotropic Agents
The changes to the Medicaid Services Manual (MSM) Chapter 1200 Prescribed Drugs regarding psychotropic medications for children and adolescents were implemented on May 16, 2016. Two separate prior authorization forms are now available for use and have replaced form FA-70 (Psychotropic Agents for Children and Adolescents):
- FA-70A - Psychotropic Agents for Children Age 0 to 5
- FA-70B - Psychotropic Agents for Children and Adolescents Ages 6 to 18
Effective May 16, 2016, FA-70A or FA-70B must be used instead of form FA-70. The forms are available on the Pharmacy Forms webpage at www.medicaid.nv.gov.
If you have questions regarding the new forms or prior authorizations, please call the Clinical Pharmacy Services Call Center for Nevada Medicaid at (855) 455-3311.
Web Announcement 1148
Issue Corrected Regarding Outpatient Claims That May Have Paid Twice
Some outpatient claims, including crossover claims, with prior authorization requirements that processed after November 18, 2013, and before July 20, 2015, may have incorrectly paid twice. The technical issue has been corrected. The affected claims may be automatically reprocessed. A future web announcement will notify providers if the claims will be reprocessed.
Web Announcement 1147
Attention All Nevada Medicaid Providers that Request Level of Care and Pre Admission Screening and Resident Review
Effective July 1, 2016, providers will be required to submit Level of Care (LOC) and Pre Admission Screening and Resident Review (PASRR) screenings through the Long Term Care (LTC)/PASRR online system. For providers not already using the LTC/PASRR system, please be advised that you must be registered to use the Electronic Verification System (EVS) in order to access the LTC/PASRR system. If you have not registered to use EVS, please go to www.medicaid.nv.gov and select the “EVS” tab to register or review the EVS User Manual Chapter 1 for step-by-step instructions. For assistance with obtaining a secured EVS login, contact the Hewlett Packard Enterprise Field Representatives at NevadaProviderTraining@hpe.com.
After registering through EVS, facilities may then register for access to the LTC/PASRR system. A Quick Reference Guide has been published that includes instructions regarding requesting a role within an organization, approving roles and removing users. The “Instructions for Requesting Roles, Approving Roles and Removing Users in the PASRR Web Portal” is on the Prior Authorization Training Materials webpage at www.medicaid.nv.gov (select “Training Materials” from the “Prior Authorization” tab). For assistance with registering for the LTC/PASRR system, contact the Hewlett Packard Enterprise PASRR/LOC staff at (800) 525-2395.
Web Announcement 1146
Attention Provider Types 38, 39, 48, 55, 57, 58 and 59: Explanation of Benefits from Other Health Care Provider Not Required
Effective with claims processed on or after December 21, 2015, provider types 38, 39, 48, 55, 57, 58 and 59 are not required to submit an Explanation of Benefits (EOB) or denial letter from the other health care (OHC) coverage provider with their Nevada Medicaid claims. The Billing Guidelines for these provider types have been updated with this information.
Web Announcement 1145
Medicaid Services Manual Chapters Updated
Updates to the following Medicaid Services Manual (MSM) chapters were approved at the Division of Health Care Financing and Policy (DHCFP) Public Hearing held on April 14, 2016.
Changes effective April 15, 2016:
- MSM Chapter 600 – Physician Services
Changes effective May 1, 2016:
- MSM Chapter 400 – Mental Health and Alcohol/Substance Abuse Services
- MSM Chapter 1300 – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Changes effective May 16, 2016:
- MSM Chapter 1200 – Prescribed Drugs
These MSM chapters have been updated and are posted on the DHCFP Medicaid Services Manual webpage. The schedule and agendas for future hearings are on the DHCFP’s Public Notices webpage.
Web Announcement 1144
Attention Provider Types 30 and 83: Changes to Authorization Request for Personal Care Services (PCS) Form FA-24 Effective June 1, 2016
The Authorization Request for Personal Care Services (PCS) form FA-24 and the corresponding FA-24 Instructions have been updated and are available on the Providers Forms webpage at www.medicaid.nv.gov. You may start using the updated form FA-24 immediately.
It is now mandatory to summarize any serious occurrences within the last 90 days of your request date. If there were none, check the box indicating “No Serious Occurrences.” Do not attach copies of serious occurrence reports to your request; simply summarize by the amount, type and severity of the occurrence. It is not necessary to provide specific dates.
- Effective June 1, 2016, requests for personal care services submitted on any previous version of form FA-24 or missing serious occurrence information will be returned to the provider and the provider will need to resubmit the request on an updated and complete FA-24.
- The new serious occurrence section of form FA-24 does not change the requirement that serious occurrences must be reported to the Division of Health Care Financing and Policy (DHCFP) District Office Care Coordination Unit within 24 hours of discovery.
Web Announcement 1143
American Dental Association (ADA) Dental Codes D0330, D2920 and D5899 Updated in MMIS
Effective on claims processed on or after May 16, 2016, the following American Dental Association (ADA) dental codes have been updated in the Medicaid Management Information System (MMIS) to process appropriately per the service limitations.
- D0330 (Dental panoramic film): The service limit is 1 service unit per 3 years.
- D2920 (Dental re-cement or re-bond crown): The service limit is 1 unit per 12 months per tooth. A prior authorization is needed to exceed the limitation.
- D5899 (Removable prosthodontic procedure; denture identification imbedding): The service limit is 2 units per 5 years. A prosthetic must have been billed in the past 12 months from the date of service on the claim. A prior authorization is needed to exceed the limitation in the case of denture/partial override requests.
Web Announcement 1142
Attention Provider Type 38: Notification Regarding Claims Denied with Edit Codes 0883 and 0884
Provider type (PT) 38 (Home & Community Based Waiver – Individuals with Intellectual Disabilities and Related Conditions) claims submitted electronically may have denied inappropriately with edit code 0883 (NPI/API Submitted is Invalid) due to a technical issue during electronic claims processing. The issue was corrected on April 29, 2016. The affected claims that denied inappropriately have been automatically reprocessed. The results of the reprocessed claims appear on remittance advices dated May 13, 2016.
PT 38 providers who bill with an Atypical Provider Identifier (API) instead of a National Provider Identifier (NPI) are reminded to be sure to bill with a correct and valid API. If you have questions on the validity of your API or if your claims have denied with edit code 0884 (API not on file), please verify the number with the Provider Enrollment department (877-638-3472) and resubmit your claims with your correct API.
Web Announcement 1141
Attention Nursing Facility and ICF/IID Provider Types 19 and 68: Tracking Process Is Changing on July 1, 2016
The Nursing Facility and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) tracking process will be changing as of July 1, 2016. Starting on July 1, 2016, providers will need to submit the tracking form to Hewlett Packard Enterprise via the Long Term Care (LTC)/PASRR system. Tracking forms will not be accepted by the Division of Health Care Financing and Policy (DHCFP) as of July 1, 2016.
Provider training sessions are being scheduled in June and July to assist providers in learning the new process. In the near future, it will be mandatory to use the PASRR system to submit the form. For this reason, please be sure to attend the training. Please visit the 2016 Nevada Medicaid Provider Training Registration website to register for one of the following training opportunities:
|Training for Nursing Facility and ICF/IID Providers
|June 9, 2016
8:30 a.m. to 10:30 a.m.
|June 23, 2016
1:00 p.m. to 3 p.m.
|July 12, 2016
8:30 a.m. to 10:30 a.m.
|Training for ICF/IID Providers Only
|June 16, 2016
3:00 p.m. to 5:00 p.m.
|June 23, 2016
3:00 p.m. to 5:00 p.m.