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]
Nevada Medicaid and Nevada Check Up News (First Quarter 2015 Provider Newsletter) [Read]
Provider Web Portal Quick Reference Guide (Updated April 16, 2012)
Web Announcement 937
Attention Personal Care Services (PCS) Provider Types 30 and 83: Updates Regarding Faxing Requests and Using the Provider Web Portal
Effective immediately: For purposes of protecting health information and for processing individual recipient requests, Personal Care Services (PCS) provider types 30 and 83 are required to send one fax per recipient, regardless of the type of request or information being faxed to HP Enterprise Services (HPES). Multiple requests received in one faxed bundle will no longer be processed.
Providers are reminded to check the HPES Nevada Medicaid provider website (www.medicaid.nv.gov) at least weekly for any pertinent web announcements, as HPES will no longer send courtesy faxes to PCS providers regarding upcoming changes. Please note that web announcements may be posted daily to inform providers on topics such as the latest Medicaid news, upcoming changes, information on billing and claims, Payerpath electronic claims submission, rates and future provider trainings.
PCS providers who are not currently registered to utilize the Provider Web Portal are encouraged to do so in order to verify recipient eligibility and obtain and view prior authorizations. Registration and use of the Provider Web Portal is accessed through www.medicaid.nv.gov. Select “HPES Login” from the “EVS” tab. The EVS User Manual, which is accessed from the same “EVS” tab, provides instructions for registering, verifying eligibility, viewing prior authorizations and verifying claim status.
Per Web Announcement 773, item number 5, the courtesy authorization page may no longer be faxed with every Functional Assessment Services Plan effective August 1, 2014. Agencies must utilize the Electronic Verification System (EVS) to obtain their prior authorization number and to view authorized units and authorized dates of service. HPES will not fax copies of the courtesy authorization page and receipt of this authorization page is not a guarantee of authorized services; authorizations must be verified by utilizing EVS.
Web Announcement 936
ICD-10 Testing Encouraged before Implementation Date
Trading partners and providers are highly encouraged to test prior to the federal mandate date for ICD-10, which is October 1, 2015. 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.
Trading partners and providers who are interested in testing ICD-10 claim transactions may contact HPES at firstname.lastname@example.org to be added to our contact list.
HPES has posted useful ICD-10 Frequently Asked Questions on the Provider Billing Information webpage at: https://www.medicaid.nv.gov/providers/BillingInfo.aspx.
- Testing is scheduled to begin the week of July 6, 2015.
- HPES will contact trading partners who have been added to our contact list to begin the testing process the week of July 6, 2015.
- HPES will publish testing instructions and end-to-end testing schedule on July 6, 2015, on the Providers Electronic Claims/EDI webpage at https://www.medicaid.nv.gov/providers/edi.aspx
- 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 935
Urgent: Payment Delay for Certain Claims
Due to the upcoming end of the Nevada state fiscal year on June 30, 2015, it is anticipated that there may be a delay in claims payment for a small amount of claims for services provided to a certain Nevada Medicaid recipient population. The pended claims could potentially affect all provider types. Any affected claims will pend with edit code 0291 (Suspended for Budget Relief). Affected claims that would normally pay on remittance advices dated June 26, 2015, will automatically be released for adjudication on remittance advices dated July 3, 2015. If this creates a hardship for your business, please contact NevadaProviderTraining@hp.com to explore the possible solutions for an advance payment.
Providers are reminded that they can avoid holding for a Customer Service Call Center representative by verifying the status of claims through the Electronic Verification System (EVS) on the Provider Web Portal or the Automated Response System (ARS).
- EVS is accessed through the Nevada Medicaid website at www.medicaid.nv.gov. Select the “EVS” tab to review the User Manual and to register or login to EVS. EVS User Manual Chapter 3 provides step-by-step instructions on searching and viewing claims that providers have submitted.
- ARS is accessed by telephone by calling (800) 942-6511.
Web Announcement 934
Automated, Online Provider Enrollment/Revalidation to be Implemented in 2015
HP Enterprise Services (HPES), in partnership with the Nevada Division of Health Care Financing and Policy (DHCFP), is working on a web-based Provider Enrollment Portal to automate provider enrollment. The Provider Enrollment Portal will allow providers to complete new enrollment, revalidation and provider changes using a web-based application. Future web announcements on this website (www.medicaid.nv.gov) will notify providers of the implementation date for the Provider Enrollment Portal.
Web Announcement 933
Payerpath Claim Submission Training for July 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: email@example.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.
||7 to 8 a.m.
||7 to 8 a.m.
||7 to 8 a.m.
||7 to 8 a.m.
||12 to 1 p.m.
*All times indicated are Pacific Time (PT).
Web Announcement 932
Attention Provider Type 33: Policy Refresher on Durable Medical Equipment Rent-to-Purchase Option
Per Medicaid Services Manual (MSM) Chapter 1300, Sections 1303.3, 1303.3.a.4.a and b: Items identified in the DMEPOS Fee Schedule with a rental and purchase option require prior authorization to determine if the recipient’s needs justify rental or purchase based on the item prescribed, the individual’s anticipated length of need and prognosis (as determined by the prescriber) and cost effectiveness to the Division of Health Care Financing and Policy (DHCFP)/Nevada Medicaid and Nevada Check Up.
a) The DHCFP allows rental of certain DMEPOS items up to the provider’s Usual and Customary Charge (UCC) for purchase, or the maximum Medicaid allowable purchase price of the item; whichever is less.
b) Unless the item is identified in the DMEPOS Fee Schedule as a rental only, once the total cumulative rental payments have reached the lower of UCC or maximum Medicaid allowable purchase rate, the item is considered purchased in full and recipient-owned.
Web Announcement 931
Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines
The Division of Welfare and Supportive Services (DWSS) will be conducting Hospital Presumptive Eligibility (HPE) training(s) for providers who would like to participate in the Hospital Presumptive Eligibility determination process. The HPE trainings will be held on a quarterly basis. The next three-day training sessions are scheduled for:
DWSS – Carson City District Office
2533 N. Carson St.
Carson City, NV 89706
DWSS - Southern Professional Development Center
701 N Rancho Rd
Las Vegas, NV 89107
|August 10 – August 12
||August 10 – August 12
|October 19 – October 21
||October 19 – October 21
In an effort to maximize state resources, as training time and space is very limited, it has been requested by DWSS that the minimum requirements be established as follows:
- In order to qualify for HPE enrollment training, Addendums and sign-up sheets must be completed, signed by the Hospital Administrator and approved by the Division of Health Care Financing and Policy (DHCFP) 10 business days prior to the date of the requested training. If the 10-day deadline is not met, the provider will need to wait to sign up for the next available training session.
- A minimum of 5 individuals will need to be enrolled in order for the training to be held, not to exceed 18 attendees (Northern Nevada) and 15 attendees (Southern Nevada).
- If the minimum class size cannot be established in either Northern Nevada or Southern Nevada, the provider will have the option of sending their attendees to the location that has the largest attendance. For instance, if there are 3 individuals registered to attend the Northern class and 10 individuals are registered for the Southern class, the training will be held in the South and the provider has the option of sending the attendees from the North to the location in the South or waiting for the next quarterly training.
The HPE Provider Addendum and the associated training sign-up sheet can be found on the Provider Enrollment webpage at www.medicaid.nv.gov. Please ensure all registration information is submitted to DHCFP@DHCFP.nv.gov within 10 business days prior to the date of each training session as training space is limited.
Once your registration has been approved, a confirmation email will be sent to you regarding the time and location of the training.
If you have any questions or concerns, please contact Ashley Barton at firstname.lastname@example.org.