• Nevada Medicaid and Nevada Check Up News [ Read]
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Urgent Notification

On April 22, 2016, the Provider Web Portal online prior authorization system experienced an issue with prior authorizations (PAs) being created without a Prior Authorization number being generated on the “Authorization Receipt” page. Please be advised these prior authorizations may not be on file, and will need to be recreated to ensure processing. Providers can try to search for the PAs that were created on April 22, 2016, by using the “View Authorization Status” page and search using recipient information. If no PAs are found, then the provider will need to re-create the PA and submit it for processing. Due to the system outage, providers who encountered issues on April 22, 2016, will be given one additional day for PA submission timeliness. We apologize for any inconvenience.

Latest News

Nevada Medicaid Community Paramedicine Provider Training and Enrollment Session [Web Announcement 1128]

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 (First Quarter 2016 Provider Newsletter) [Read]

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

Web AnnouncementsView All

Web Announcement 1133

Attention Provider Type 47: Indian Health Program Crossover Encounter Claims

Indian Health Program (IHP) (provider type 47) encounter claims for code T1015 (Clinic service) that were Medicare crossover claims processed on or after August 31, 2015, may have denied inappropriately for edit codes 0301, 0303, 0201 or 0202 (duplicate payment requests or duplicate history). Effective with claims processed on or after April 25, 2016, these claims will no longer deny inappropriately. The affected Medicare crossover claims that processed on or after August 31, 2015, and before April 25, 2016, will be automatically reprocessed. A future web announcement will notify providers when the claims will be reprocessed.

Reminder: The limitation for encounter code T1015 for provider type 47 is five (5) encounters per day. Claims exceeding this limitation will be denied with edit code 0213 (Service limits exceeded, 5 units).

Web Announcement 1132

Attention Provider Types 12, 17 (specialties 166, 174, 179, 195, 196 and 198), 20, 24, 28, 60, 74 and 77: Gardasil® 9 HPV vaccine (CPT code 90651) Announcement

Gardasil® 9 HPV vaccine (Current Procedural Terminology (CPT) code 90651) has been approved by the Food and Drug Administration (FDA). Gardasil 9 HPV vaccine can be billed by provider types 12, 17 (specialties 166, 174, 179, 195, 196 and 198), 20, 24, 28, 60, 74 and 77 for male or female recipients ages 9 through 26 with dates of service on or after January 1, 2015. No prior authorization is required.

Effective with claims with dates of service on or after April 18, 2016, claims for CPT code 90651 will no longer deny with edit codes 0148 (Rendering provider is not certified to perform procedure) or 0309 (Services not covered). Claims for CPT code 90651 submitted on or after January 1, 2015, and processed before April 18, 2016, that denied with edit codes 0148 or 0309 will be automatically reprocessed. A future web announcement will notify providers when the affected claims will be reprocessed.

Reminder: Providers will bill for the vaccine administration using CPT code 90651. The vaccine serum will be billed using a National Drug Code (NDC). Only the administration will be reimbursed for Vaccines for Children (VFC) (up to 18 years old) use.

Web Announcement 1131

Outpatient Claims Affected by Edit Code 0210

Some outpatient claims, including crossover claims, have been denied in their entirety with edit code 0210 (Rate not on file) even when some lines on the claim were valid. Effective with claims processed on or after April 25, 2016, valid claim lines will process appropriately and only the invalid claim lines that are not covered will deny with edit code 0210.

Claims that denied inappropriately for edit code 0210 that had payable lines will be automatically reprocessed. A future web announcement will notify providers when the affected claims will be reprocessed.

Web Announcement 1130

Attention Provider Type 20: Pediatric Surgery Enhancement Rates Implemented

A pediatric enhancement rate has been implemented for surgical services codes 30000-39999 billed by provider type 20 (Physicians). Effective with claims processed on or after April 18, 2016, these claims will pay at the pediatric enhancement rate.

Claims submitted by PT 20 for pediatric surgical codes 30000-39999 with dates of service on or after January 1, 2016, that processed before April 18, 2016, and paid at the regular rate will be automatically reprocessed. A future web announcement will notify providers when the claims will be reprocessed.

Web Announcement 1129

Attention Provider Type 85: ABA Services Claims Will No Longer Deny; Claims Will Be Reprocessed

Update to Web Announcement 1064: The Centers for Medicare & Medicaid Services (CMS) has approved the rates for Applied Behavior Services (ABA). The Medicaid Management Information System (MMIS) has been updated. Effective with claims processed on or after March 22, 2016, claims for ABA services submitted by provider type 85 (specialties 000, 310, 311, 312 and 314) will no longer deny for edit code 0309 (Services not covered). Providers may submit claims with dates of service on or after January 1, 2016.

Claims submitted with dates of service on or after January 1, 2016, and processed before March 22, 2016, that denied with edit code 0309 will be automatically reprocessed. These claims billed with UD Modifier that denied inappropriately will also be automatically reprocessed. A future web announcement will notify providers when the claims will be reprocessed.

Web Announcement 1128

Nevada Medicaid Community Paramedicine Provider Training and Enrollment Session

Hewlett Packard Enterprise, in partnership with the Division of Health Care Financing and Policy (DHCFP), will be conducting a training event and enrollment session for the new Community Paramedicine Program. This targeted training event will include an introduction to the Nevada Medicaid Program, an overview of the Community Paramedicine Program, website navigation, and a billing overview. An additional hour has been added to each session to include assistance with enrollment for Nevada Medicaid. Managed Care Organizations will be on site to answer additional enrollment questions.

Please visit the 2016 Nevada Medicaid Provider Training Registration website to register for one of the following training opportunities:

Northern Nevada Southern Nevada
May 2, 2016
8:00 a.m. to noon
Hewlett Packard Enterprise Training Location
9850 Double R Blvd
Reno, NV 89521
May 24, 2016
8:00 a.m. to noon
Las Vegas District Office
1210 South Valley View Blvd Suite 104
Las Vegas, NV 89102
May 2, 2016
1:00 p.m. to 5:00 p.m.
Hewlett Packard Enterprise Training Location
9850 Double R Blvd
Reno, NV 89521
May 24, 2016
1:00 p.m. to 5:00 p.m.
Las Vegas District Office
1210 South Valley View Blvd Suite 104
Las Vegas, NV 89102

For additional information about this program, please visit the DHCFP Community Paramedicine website.

Web Announcement 1127

Payerpath Claim Submission Training for May 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: 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 May 3 7 to 8 a.m.
ADA Wednesday May 4 7 to 8 a.m.
CMS-1500 Tuesday May 10 7 to 8 a.m.
UB Wednesday May 11 7 to 8 a.m.
CMS-1500 Wednesday May 18 7 to 8 a.m.

*All times indicated are Pacific Time (PT).

Web Announcement 1126

Update for Provider Type 85: Telehealth Services Claims Will No Longer Deny

Update to Web Announcement 1078: The Centers for Medicare & Medicaid Services (CMS) has approved HCPCS code Q3014 (Telehealth originating site facility fee) to be billed by Applied Behavior Analysis (ABA) provider type 85 (specialties 000, 310, 311, 312 and 314). The Medicaid Management Information System (MMIS) has been updated. Effective with claims dates of service on or after March 30, 2016, PT 85 claims for Q3014 will no longer deny with edit code 0148 (Rendering provider not certified to perform procedure).

Claims for code Q3014 submitted by PT 85 with dates of service on or after January 1, 2016, through March 30, 2016, that denied with edit code 0148 will be automatically reprocessed. Providers will be notified in a future web announcement when the claims will be reprocessed.

Web Announcement 1125

Provider Documentation Reminders

The following reminders will assist providers in adhering to the documentation responsibilities required of each Nevada Medicaid/Nevada Check Up provider.

  • It is the provider’s responsibility to submit clean, accurate, complete and legible claims and supporting documentation upon request.
  • Requested documentation must be provided within timeframes specified by the Division of Health Care Financing and Policy (DHCFP) or other state and/or federal officials or their authorized agents for the purpose of determining the validity of claims and the reasonableness and necessity of all services billed to and paid by the DHCFP.
  • It is the provider’s responsibility to adhere to program and provider type specific documentation requirements in the Medicaid Services Manual (MSM), Billing Manual and the Billing Guidelines for each provider type.

Please review the provider responsibilities specified in Medicaid Services Manual (MSM) Chapters 100 (Medicaid Program), 3300 (Program Integrity) and the chapters related to the services you provide. The MSM is located on the http://dhcfp.nv.gov/ website. The Billing Manual and Billing Guidelines are located on the Providers Billing information webpage at https://www.medicaid.nv.gov/providers/BillingInfo.aspx.

Web Announcement 1124

Attention Provider Type 38: Procedure Codes and Modifiers Updated

Procedure codes and modifiers that can be billed by provider type (PT) 38 (Waiver for Individuals with Intellectual Disabilities and Related Conditions) have been updated in the Medicaid Management Information System (MMIS).

The following codes and modifiers are billable by PT 38 effective with dates of service on or after April 1, 2016:

Procedure Code Modifier
97802
97802 TN
97803
97803 TN
T2019
T1001
T2024 HN
T2024 HO

The following code and modifiers are billable by PT 38 with dates of service on or after January 1, 2016:

Procedure Code Modifier
T1002
T1002 TV
T1002 U2
T1002 U1

Please note:

  • Effective with dates of service on or after April 1, 2016, procedure code S9470 (with and without modifiers) is no longer billable by PT 38.
  • PT 38 must bill procedure code T2024 with modifier HN or HO.

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.

The Nevada Division of Health Care Financing adheres to all applicable privacy policies and standards, including HIPAA rules and regulations, regarding protected health information. Click here to see the State of Nevada Online Privacy Policy

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