• Nevada Medicaid and Nevada Check Up News [ Read]
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  • Preferred Drug List Announcements [ Review]
  • Diabetic Supply Program [ Details ]
  • Save money. Save time. E-Prescribe. [ Details ]
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]

Update for Pharmacies: Override Period for Point-of-Sale Processing for Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners Ends February 5, 2015 (Updated December 9, 2014, and January 9, 2015) [Web Announcement 825]

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

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

Web AnnouncementsView All

Web Announcement 914

Services for Children with Autism Spectrum Disorder

On July 7, 2014, the Center 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.

The DHCFP is taking the following steps:

  • A series of workshops were held to gain stakeholder input on ABA policy development of medical coverage policy, reimbursement and provider qualifications. The workshop agendas and associated materials can be found on the DHCFP website at: http://dhcfp.nv.gov/publicnotices.htm.
  • Ongoing information regarding the medical coverage policy development for ABA services can be found on the DHCFP ABA webpage at: https://dhcfp.nv.gov/ABA.htm.
  • A Public Hearing will be held on the State Plan Amendment (SPA) and medical coverage policy with an anticipated effective date for the first quarter of Calendar Year 2016.
  • Policy and Rates SPA’s will be submitted for CMS approval. CMS has 90 days for comment.

Currently, Nevada Medicaid covers screenings under EPSDT. See Web Announcement 892 for details.

Future newsletters and web announcements will provide additional information regarding the medical coverage policy development for ABA services, including the prior authorization requirements and billing instructions, as the implementation date approaches. Newsletters and web announcements are posted on the Providers Announcements/Newsletters webpage at www.medicaid.nv.gov.

Web Announcement 913

Upcoming Benefit for Providers: Online Submission of Nevada Medicaid Forms

HP Enterprise Services (HPES) is currently updating the Nevada Medicaid forms that are available online on the Providers Forms webpage at https://www.medicaid.nv.gov/providers/forms/forms.aspx. These forms will be updated to a format that will allow the forms to be completed, downloaded and saved electronically. Most of the forms will be able to be submitted securely to HPES using the Provider Web Portal instead of printing and faxing. Future web announcements on this website will notify providers of the implementation date for this enhancement, which forms are affected and instructions for submitting the forms online.

Web Announcement 912

Attention Provider Type 32 Regarding Modifiers for Ambulance Claims

Effective for claims processed on or after April 20, 2015, modifiers for ambulatory services have been updated in the Medicaid Management Information System (MMIS). The Billing Guide for Provider Type 32 (Ambulance, Air or Ground) will be updated with instructions on the use of ambulance modifiers. The Billing Guide is posted on the Providers Billing Information webpage at https://www.medicaid.nv.gov.

Web Announcement 911

Payerpath Claim Submission Training for May 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: nvmmis.edisupport@hp.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 May 5 7 to 8 a.m.
ADA Wednesday May 6 7 to 8 a.m.
CMS-1500 Tuesday May 12 7 to 8 a.m.
UB Wednesday May 13 7 to 8 a.m.
CMS-1500 Wednesday May 20 Noon to 1 p.m.

*All times indicated are Pacific Time (PT). 

Web Announcement 910

Provider Types Prohibited from Billing National Drug Codes will Receive Claim Denials

Effective for claims with dates of service on or after April 20, 2015, Nevada Medicaid will have an edit in place to deny claims to provider types that should not be billing for outpatient drugs because they are already included in their reimbursement rate or they should be billing with HCPCS or CPT codes and not with National Drug Codes (NDCs). For example, provider type 33 (DME) should only bill supplies and not drugs. If a PT 33 bills an NDC, the claim will deny with edit code 0897 (Provider Type/Specialty is not allowed to bill NDC).

Only the following provider types may bill with NDCs:

PT 12: Hospital, Outpatient
PT 17: Special Clinics (all specialties except 180, 181 and 182)
PT 20: Physician, M.D., Osteopath
PT 21: Podiatrist
PT 24: Advanced Practice Registered Nurse (APRN)
PT 25: Optometrist
PT 27: Radiology and Non-invasive Diagnostic Centers
PT 37: Intravenous Therapy
PT 42: Outpatient Psychiatric Hospital, Private, and Community Health Center
PT 45: End Stage Renal Disease (ESRD) Facility
PT 55: Transitional Rehabilitative Center, Outpatient
PT 64: Hospice
PT 72: Nurse Anesthetist
PT 74: Nurse Midwife
PT 77: Physician’s Assistant

Claims from provider types not listed above must only document the HCPCS or CPT codes. If a claim is submitted from a provider type not listed above with an NDC or an NDC with the HCPCS or CPT codes, the claim will deny.

For any questions, please contact the HP Enterprise Services Customer Service Center at (877) 638-3472.

Web Announcement 909

Provider Web Portal: Search Fee Schedule Error Message Based on Provider Type

The Search Fee Schedule page of the Provider Web Portal will not allow the following provider types (PTs) to search for fees online, because additional information is required to determine their rates:

  • Home Health Agency (PT 29)
  • Ambulatory Surgical Centers (PT 46)
  • Hospice (PT 64)
  • ASC or ESRD codes for bundled rates

If a search is done using PT 29, 46 or 64, the following error message will be displayed: “Provider Type is Invalid.” If a search is done using ASC or ESRD codes that have bundled rates, the search will not return results. Please see the full Web Announcement 909 for screenshots showing the messages that will be displayed in the Provider Web Portal.

Web Announcement 908

Second Quarter 2015 Provider Workshops

The HP Enterprise Services (HPES) Provider Services Field Representatives will conduct several workshops for providers in the months of April, May and June. The full descriptions of the workshops can be reviewed on the 2015 Provider Training Registration website.

Please review the dates, times and topics below and register by using the 2015 Provider Training Registration website. All times indicated are Pacific Time (PT). For questions, contact the HPES Training Department at NevadaProviderTraining@hp.com.

Note: All courses are non-clinical in nature. Training modules are offered in a virtual room setting. If you would like to schedule an onsite training, please contact your Provider Services Field Representative directly. Provider Services Field Representative contact information can be found on the Provider Services Field Representative Team Territories document, which is posted on the Provider Training webpage at www.medicaid.nv.gov.

Virtual Room (This option allows registrants to attend live workshops via a virtual room setting and conference line from the convenience of their own office. Access details will be returned to you in an email 2 days prior to the session.)
Date Time Training Module
April 15 10 a.m. to 11 a.m. Getting Started on the Provider Web Portal
April 20 1 p.m. to 2 p.m. Medicaid.nv.gov Website Navigation
April 22 11:00 a.m. to noon Eligibility Benefit Verification on the Provider Web Portal
May 11 3 p.m. to 4 p.m. CMS-1500 Paper Claim Form Instructions
May 13 10 a.m. to 11 a.m. Claim Status Verification on the Provider Web Portal
May 19 8 a.m. to 9 a.m. ADA Paper Claim Form Instructions
May 21 11:00 a.m. to noon Prior Authorization Submission and Review on the Provider Web Portal
June 8 1 p.m. to 2 p.m. Claim Adjustments and Voids
June 11 noon to 1 p.m. UB-04 Paper Claim Form Instructions
June 16 3 p.m. to 4 p.m. Provider Payment History and Remittance Advice (RA) Access on the Provider Web Portal
June 17 8 a.m. to 9 a.m. Claim Appeals
June 22 11 a.m. to noon Search Fee Schedule and Authorization Criteria on the Provider Web Portal
June 24 10 a.m. to 11 a.m. Medicaid.nv.gov Website Navigation
June 25 3 p.m. to 4 p.m. Billing Claims with Third Party Liability (TPL)

 


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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