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URGENT: Claim Form Field Instructions for Entering NPI of Ordering, Prescribing or Referring Provider[Web Announcement 830]

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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 888

Attention Elko Area Providers: Training Sessions Scheduled March 12-13, 2015, for Currently Enrolled Providers and Providers Who Are Considering Enrolling

An HP Enterprise Services (HPES) Provider Services Field Representative will present individual training sessions for currently enrolled Nevada Medicaid providers and a session for providers who are considering enrolling as a Nevada Medicaid provider.

The individual sessions are open to currently enrolled providers who would like to review claims, learn the resources and tools available to them for use as a Nevada Medicaid provider, and/or discuss general questions and answers. The individual sessions will take place one day only on Thursday, March 12, 2015. There are six (6) one-hour time openings available:

  • 8:00 a.m. to 9:00 a.m.
  • 9:30 a.m. to 10:30 a.m.
  • 11:00 a.m. to noon
  • 1:00 p.m. to 2:00 p.m.
  • 2:30 p.m. to 3:30 p.m.
  • 4:00 p.m. to 5:00 p.m.

To register for one of the individual sessions, please send an email directly to kim.nal.teixeira@hp.com with the time attending, your name, contact telephone number and your National Provider Identifier (NPI) or Atypical Provider Identifier (API). In case of a time conflict, the first request received will be registered for the time slot and the second request received will be scheduled for the next time slot available. An email confirmation will be sent back to you confirming your time slot.

The session for those providers who are considering enrolling with Nevada Medicaid and would like to get more information before making that decision will begin at 9:00 a.m. and end at noon on Friday, March 13, 2015. To register, email your request to kim.nal.teixeira@hp.com. An email confirmation will be sent back to you for your reserved seat.

All sessions will be held at the Elko Hilton Gardens Hotel located at 3650 E. Idaho St., Elko, NV 89801.

  • Individual sessions will be in Ruby II Room (second floor).
  • The non-provider session will be in Ruby III Room (third floor).

 

Web Announcement 887

Provider Web Portal Search Fee Schedule Update

Update to Web Announcement 854: On February 23, 2015, an update was made to the Search Fee Schedule application that is available on the Provider Web Portal. When search results are returned, the default sort is now based on the “Effective Date” column, as shown below. The caret symbol next to “Effective Date” will default to show effective dates in descending order.

Web Announcement 872

Note: In addition to the Effective Date, the search results can also still be sorted by:

  • Provider Specialty
  • Modifier
  • Fee Amount
  • Age Restrictions

 

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.

 


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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