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]
Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines [Web Announcement 931]
Nevada Medicaid and Nevada Check Up News (Second Quarter 2015 Provider Newsletter) [Read]
Provider Web Portal Quick Reference Guide (Updated April 16, 2012)
Web Announcement 952
Non-Dental Provider Claims for Application of Fluoride Varnish
Claims for code D1206 (Topical fluoride varnish) submitted by PTs 12, 17 (specialties 166, 169, 174 and 195), 20, 24 and 77 and code D1208 (Topical application of fluoride) submitted by PT 20 with dates of service April 20, 2014, through December 31, 2014, that denied for edit code 0210 (No pricing segment on file) will be reprocessed. The results of the reprocessed claims will be reflected on remittance advices dated August 7, 2015.
Effective on claims with dates of service on or after January 1, 2015, provider types (PTs) 12, 17 (specialties 166, 169, 174 and 195), 20, 24 and 77 may bill CPT code 99188 (Application of fluoride varnish by physician or other qualified health care professional).
Web Announcement 951
Provider Type 85 Applied Behavior Analysis (ABA) Group Enrollment Checklist Is Online
The Provider Enrollment Checklist for group enrollment for Applied Behavior Analysis (ABA) (provider type 85 specialty 000) is now available on the Provider Enrollment Checklists webpage at https://www.medicaid.nv.gov/providers/checklist_pt85.aspx. HP Enterprise Services is now enrolling PT 85 groups.
Please see Web Announcement 940 for information regarding ABA group and individual enrollment.
- Individuals enrolling with specialties 312, 313 or 314 are asked not to enroll until the group that their National Provider Identifier (NPI) will be linked to has been enrolled. Individuals with these three specialties must, upon enrollment, be linked to a group and therefore may submit their individual applications as part of a PT 85 group enrollment application. Enrollment applications submitted for these specialties will be returned if the group NPI identified in Field 5 of the Provider Initial Enrollment Application (Individuals) is not currently enrolled with Nevada Medicaid.
- Individuals enrolling with either specialty 310 (Licensed and Board Certified Behavior Analyst (BCBA)) or specialty 311 (Licensed Psychologist) and practicing independently and not as part of a group/agency are to complete the Provider Initial Enrollment Application (individuals).
Web Announcement 950
Attention Nursing Facilities: Level of Care (LOC) Assessment for Specialty Care Recipients
Effective immediately, when accepting a specialty care recipient (e.g., Pediatric Care I/II or Ventilator Care), nursing facilities will now have a 72-hour grace period from date of admission to complete the specialty Level of Care (LOC) assessment as long as the standard LOC and Preadmission Screening and Resident Review (PASRR) are completed prior to admission. In the case that a standard LOC and PASRR are not completed prior to admission, normal penalties will be enforced. Nursing facilities should submit a nursing facility tracking form after the specialty LOC has been completed.
Web Announcement 949
Save the Date: PASRR Workshop Scheduled for August 18, 2015
The Nevada Medicaid Long Term Support Services program is sponsoring a free workshop entitled “PASRR – Nevada Specific” on Tuesday, August 18, 2015. The workshop will be held from 9 a.m. to 4:30 p.m. in Room 2134 of the Legislature Building, 401 S. Carson St., in Carson City. The event will be led by a guest speaker from the PASRR Technical Assistance Center (PTAC), and will be of interest to anyone who is involved with the Preadmission Screening and Resident Review (PASRR) process, including case managers, social workers, Minimum Data Set (MDS) staff, directors of nursing, and physician and nursing staff. All State agencies are welcome. The workshop will be video-conferenced to the Grant Sawyer Building, 555 E. Washington Blvd., Conference Room 4401, in Las Vegas.
Registration is required. For information or to request a registration form to attend, please contact Cheryl Baldovi at firstname.lastname@example.org.
Please note: This workshop is a general overview of the PASRR program. It is not an HP Enterprise Services (HPES) technical training. Some of the topics that may be presented include the objective, purpose and history of the PASRR program, categories and qualifiers, and specialized services.
Web Announcement 948
It’s 10 Weeks until the ICD-10 Implementation on 10/01/15. Are You Ready?
It is 10 weeks until the October 1, 2015, federal deadline for the ICD-10 implementation. Trading partners and providers are highly encouraged to test prior to the federal mandate date for ICD-10. It is critical that trading partners and providers test with Nevada Medicaid prior to the mandated date to ensure readiness for all parties and reduce the impact of this implementation for all parties, which could potentially have negative impacts on provider payments.
Providers who use a clearinghouse to submit claims are encouraged to contact their clearinghouse to make sure they test with HP Enterprise Services (HPES) prior to the mandated date for ICD-10.
HPES has posted useful ICD-10 Frequently Asked Questions on the Provider Billing Information webpage at: https://www.medicaid.nv.gov/providers/BillingInfo.aspx.
- HPES has started ICD-10 Trading Partner Testing. HPES has published ICD-10 Testing Instructions and an end-to-end ICD-10 Testing Schedule on the Providers Electronic Claims/EDI webpage at https://www.medicaid.nv.gov/providers/edi.aspx. Please take time to look over this information as well as the FAQs. If you have any questions, or would like to participate in ICD-10 testing, you may contact HPES at email@example.com.
- Mandatory compliance date October 1, 2015
- Federal mandate under Health Insurance Portability and Accountability Act (HIPAA) regulations
- National impact: mandatory for all HIPAA-covered entities such as hospitals, physicians, dental providers, long-term care providers, DME providers, small provider offices, laboratories, clearinghouses, hardware/software vendors and billing agencies
Web Announcement 947
Provider Type 22 Specialty 079 (Orthodontia) Can Bill Codes D0330, D0350 and D0470
Effective on claims with dates of service on or after March 1, 2015, provider type 22 (Dentist) specialty 079 (Orthodontia) can bill CDT codes D0330 (Dental panoramic film), D0350 (Oral/facial photo images) and D0470 (Diagnostic casts). These CDT codes are currently required as part of the process that the orthodontist must follow before requesting a prior authorization for Orthodontic treatment.
Web Announcement 946
Provider Type 22: Service Limitations for CDT Codes D0350, D0460, D9110 and D9930
Effective June 23, 2015, the service limits for the following dental codes have been updated in the Medicaid Management Information System (MMIS):
- D0350 (Oral/facial photo images): 1 service unit per 12 rolling months
- D0460 (Pulp vitality test): 1 service unit per patient, per day, same provider
- D9110 (Treatment dental pain – minor procedure): 1 service unit per patient, per day, same provider, and 2 units per 6 months
- D9930 (Treatment of complications): 1 service unit per 12 rolling months
Please note: Effective May 12, 2015, CDT code D9430 (Office visit during hours, no other procedures provided) is no longer covered.
The Coverage, Limitations and Prior Authorization Requirements for the Nevada Medicaid and Nevada Check Up Dental Program (Attachment A of the Provider Type 22 Billing Guide) has also been updated to reflect the above limitations.
Web Announcement 945
Payerpath Claim Submission Training for August 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.
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*All times indicated are Pacific Time (PT).
Web Announcement 944
Paper Claims with Zero Payment from Primary Do Not Require Special Batch
As of April 21, 2015, claims with zero payment from the primary (Third Party Liability) no longer require special batch. A system enhancement was completed to allow claims with zero payment from a primary to suspend for manual review of TPL (Edit 0313 Bill Any Other Available Insurance) when submitted on paper with the primary EOB attached.
Web Announcement 943
Notice for Provider Type 63: Residential Treatment Center (RTC) AKA Psychiatric Residential Treatment Facility (PRTF) Regarding Critical Event Reporting
Consistent with Medicaid Services Manual (MSM) Chapter 400 Section 403.8B2, the following critical events reporting requirements are the responsibility of the Residential Treatment Center (RTC) provider. Information that must be reported includes, but is not limited to, deaths, injuries, assaults, suicide attempts, police or sheriff’s investigations and physical, sexual or emotional abuse allegations. In addition, providers must report serious injuries. Serious injury means any significant impairment of the physical condition of the resident as determined by qualified medical personnel. This includes, but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether accidental, self-inflicted or inflicted by someone else. Notifications should be made to Medicaid via secure email to email@example.com or by fax to (775) 684-3762.
Providers will report the following information and indicate if notifications were made to the entities listed below:
- Date of Incident
- Recipient’s Name or Initials
- Recipient’s Nevada Medicaid Number (11 Digit Id Number)
- Facility Behavioral Health Supervisor
- Notification to QI0-Like Vendor (HP Enterprise Services)
- Notification to Parent/Guardian
- Notification to Centers for Medicare & Medicaid Services
- Notification to Accrediting Body
- Notification to Division of Child and Family Services
- Notification to Case Manager
- Notification to Law Enforcement
For information regarding the policy requirements, please contact Hilary Jones, R.N., HCC III at (775) 684-3753.