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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 (Fourth Quarter 2014 Provider Newsletter) [Read]

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

Web AnnouncementsView All

Web Announcement 886

Provider Web Portal Pharmacy PA Link Access Revised

Update to Web Announcement 875: Effective February 16, 2015, the Pharmacy prior authorization (PA) link on the Provider Web Portal will be displayed for providers that have at least one of the following prescriber provider types associated with their National Provider Identifier (NPI): 12, 17, 20, 21, 22, 24, 25, 27, 42, 45, 55, 64, 72, 74 or 77.

Web Announcement 885

Claim Denials for Edit Code 0367 (Bill Medicare)

The Nevada Medicaid Management Information System (MMIS) has been updated with the current versions of CPT and HCPCS codes per the Centers for Medicare & Medicaid Services (CMS) to ensure claims do not receive edit code 0367 (Bill Medicare) for services that Medicare does not cover. These services, non-covered under Medicare, will now bypass this edit code (0367) to process under Medicaid. The service may or may not be a covered service under Medicaid and the adjudication will now correctly reflect the appropriate outcome.

Web Announcement 884

Payerpath Claim Submission Training for March 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 March 3 7 to 8 a.m.
ADA Wednesday March 4 7 to 8 a.m.
CMS-1500 Tuesday March 10 7 to 8 a.m.
UB Wednesday March 11 7 to 8 a.m.
CMS-1500 Wednesday March 18 noon to 1 p.m.

*All times indicated are Pacific Time (PT). 

Web Announcement 883

Payment Error Rate Measurement (PERM) Review in Progress

The Centers for Medicare & Medicaid Services (CMS) measures the accuracy of Medicaid and Children’s Health Insurance Program (CHIP) payments made by each state for services rendered to recipients through the Payment Error Rate Measurement (PERM) program. Under the PERM program, CMS uses national contractors to measure improper payments in Medicaid and CHIP. The PERM review is currently in progress for Nevada on claims paid during the period October 1, 2013, through September 30, 2014.

A+ Government Solutions, Inc., a statistical contractor, provides statistical support to the program by producing the claims to be reviewed and by calculating Nevada’s error rate. A+ Government Solutions, Inc. will collect medical policies from the State, collect medical records from providers, and will also conduct the medical and processing reviews for sampled claims following guidance provided by CMS.

Medical records are needed to support the medical reviews to determine if the service provided was medically necessary and correctly paid in accordance with established policy. A+ Government Solutions, Inc. will contact you, the provider, to verify your name and address and to determine how you want to receive the medical record request(s) (via facsimile, U.S. mail). Once the provider receives the request for medical records, the provider must submit the information electronically or in hard copy within 75 days.

A+ Government Solutions, Inc. will follow up to ensure that providers submit the documentation before the 75-day time frame has expired. If the provider fails to submit appropriate and sufficient documentation to support the claim billed to and paid by the DHCFP within the allotted time frame, the payment will be considered an error and will be recovered from the provider. Past studies indicate the largest cause of errors occur in the medical review area and are due to the provider sending either no documentation or insufficient documentation. Providers may access additional PERM information at www.cms.gov/PERM.

Web Announcement 882

Update Regarding 2015 New CPT, HCPCS and ADA Codes

Rates for the new 2015 CPT, HCPCS and ADA codes are in the process of being updated in the Nevada Medicaid Management Information System (MMIS). Providers are advised to use the appropriate 2015 codes, when applicable, on claims with dates of service on or after January 1, 2015. Note: The claims will deny with edit codes 0210 (No fees found on file) and/or 0309 (Services not covered) and/or 0148 (Rendering provider is not certified to perform procedure). The denied claims will be automatically reprocessed after the rates are updated in the MMIS with no further action required by providers.

Providers will be notified via web announcement when the 2015 codes are updated in the MMIS and the affected claims are reprocessed.

Web Announcement 881

CAQH CORE 350: Health Care Claim Payment/Advice (835) Infrastructure Rule

Effective February 11, 2015, the Nevada Medicaid program has implemented the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) Operating Rules CAQH CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule.

This CAQH CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule supports the CORE “Safe Harbor” connectivity requirement.

By requiring the delivery and use of these CORE infrastructure requirements when conducting the v5010 X12 835, the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule helps provide the information that is necessary to electronically process a claim payment and corresponding remittance details and thus reduce the current cost of today‘s paper-based transaction process.

The solution will not require trading partners to remove existing connections that do not match the rule, nor will it require that all covered entities use only this method for all new connections. A trading partner may decide to continue to use the current connection or use the new “Safe Harbor” connectivity method at their discretion.

If you are interested in using this method, please contact HP Enterprise Services (HPES) at (877) 638-3472 (select options 2, 0 then 3) or send an email to nvmmis.edisupport@hp.com.

Web Announcement 880

Balance Due Amount Alteration Resolved

The balance due amount on some claims was being changed inappropriately when the claims were processed by the clinical claim editor. Effective January 19, 2015, this is no longer occurring. Any claims affected by this issue will be automatically reprocessed. The adjudication of the reprocessed claims will be reflected on a future remittance advice.


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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