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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]

Nevada Medicaid and Nevada Check Up News (Second Quarter 2015 Provider Newsletter) [Read]

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

Web AnnouncementsView All

Web Announcement 966

Attention Provider Types 12, 17 (Specialty 180), 20, 33, 34 and 44: Durable Medical Equipment Codes Updated in MMIS to Facilitate Rental and Purchase Reimbursement

Per Medicaid Services Manual (MSM) Chapter 1300, rented devices are to be considered purchased once the total cumulative rental payments equal the usual and customary purchase price or maximum Medicaid allowable purchase rate, whichever is less. The exception to this is when the item is available only as a rental (RR modifier).

The following HCPCS codes have been updated in the Medicaid Management Information System (MMIS) in order to facilitate correct reimbursement. Please note the provider types affected by each code.

  • E0303 and E0471: Has been assigned a rate for purchase (payable to provider type 17, specialty 180, and PTs 12, 20, 33, 34 and 44)
  • E0445: Has been assigned a rate for purchase (payable to PT 33 only)
  • K0003, K0004 and K0195: Require a prior authorization effective with dates of service on or after September 1, 2015 (payable to PT 17 specialty 180 and PT 33 only)
  • E0618: Has been assigned a purchase rate and requires a prior authorization effective with dates of service on or after September 1, 2015 (payable to PT 17 specialty 180 and PT 33 only)
  • E0619: Has been assigned a purchase rate and requires a prior authorization effective with dates of service on or after September 1, 2015 (payable to PT 33 only)
  • K0738: Has been assigned a rental rate and requires prior authorization for rental effective with dates of service on or after September 1, 2015 (payable to PT 33 only)

Web Announcement 965

Save the Date: 2015 Annual Medicaid Conference Scheduled for October

Nevada Medicaid and Nevada Check Up providers (all provider types) are urged to attend the 2015 Annual Medicaid Conference scheduled for the following dates and locations:

  • Wednesday, October 7, 2015, in Reno/Sparks: Nugget Casino Resort, 1100 Nugget Ave., Sparks (in the Rose Ballroom)
  • Thursday, October 22, 2015, in Las Vegas: Sam’s Town Hotel & Casino, 5111 Boulder Highway, Las Vegas (in the Ponderosa Ballroom)

There will be half-day morning and afternoon sessions at each location to accommodate schedules and encourage participation. The conference will include program and policy updates; it will not include technical or billing training. Additional information concerning the Annual Medicaid Conference will be posted in future web announcements on this website (www.medicaid.nv.gov); please check back frequently for conference times, topics and registration instructions.

Web Announcement 964

Rate Methodology Updates for CPT Codes Billed by Provider Types 20, 24 and 77

Effective with claims with dates of service on or after July 1, 2015, payments for services billed by provider types (PT) 20 (Physician, M.D., Osteopath, D.O.), 24 (Advanced Practice Registered Nurses) and 77 (Physician’s Assistant) using Current Procedural Terminology (CPT) codes will be calculated using the January 1, 2014, unit values for the Nevada-specific resource based relative value scale (RBRVS) and the 2014 Medicare Physicians Fee Schedule conversion factor.

These changes will be reflected in the updated Nevada State Plan Section 4.19-B Rates.

Web Announcement 963

Enhancement to Provider Web Portal Improves Prior Authorization Tracking Number Response Time

On August 24, 2015, an enhancement was made to the Provider Web Portal prior authorization (PA) system that improves the system’s response time for PAs submitted with attachments. Users should notice, after clicking submit, an improved response time for receiving the automatic Prior Authorization Tracking Number for PAs submitted with attachments.

Please note that the process for submitting PAs has not changed, and the enhancement will have no impact on the turnaround times for completion of reviews.

Web Announcement 962

Clinical Claim Editor Updated with NCCI Quarter 3 Files

Effective July 1, 2015, the clinical claim editor in the Medicaid Management Information System (MMIS) has been updated with the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Quarter 3 2015 files.

Claims processed on or after July 1, 2015, through August 21, 2015, that were not processed using the updated NCCI files will be automatically reprocessed. The results of the reprocessed claims will appear on remittance advices dated September 18, 2015.

Web Announcement 961

Claims with Modifier 57 that Denied Incorrectly will be Reprocessed

Certain claims processed on or after July 28, 2014, and before February 9, 2015, that were appropriately billed with modifier 57 may have denied incorrectly due to National Correct Coding Initiative (NCCI) edits. Affected claims will be automatically reprocessed and the results will be reflected on remittance advices dated August 21, 2015.

Web Announcement 960

Payerpath Claim Submission Training for September 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 September 1 7 to 8 a.m.
ADA Wednesday September 2 7 to 8 a.m.
CMS-1500 Tuesday September 15 7 to 8 a.m.
UB Wednesday September 16 7 to 8 a.m.
CMS-1500 Wednesday September 23 7 to 8 a.m.

*All times indicated are Pacific Time (PT).

Web Announcement 959

Pharmacy Dispensing Fee Increase and Pricing Methodology Using National Average Acquisition Cost (NADAC) Files

Effective November 1, 2015, (pending CMS approval), Nevada Medicaid will be increasing the professional dispensing fee and implementing a new drug pricing methodology using National Average Drug Acquisition Cost (NADAC) files. This is a two-part change to be in compliance with the Patient Protection and Affordable Care Act of 2010.

1. The professional dispensing fee for outpatient and retail pharmaceuticals will be increased.

a. The State’s dispensing fee for all outpatient retail pharmacies is increasing from $4.76 to $10.17 per prescription.

b. IV therapy and long term care (LTC) will receive the same dispensing fee as the retail pharmacies; per policy their rate will be daily.

c. The dispensing fee for supplies, including diabetic supplies, will remain unchanged.

2. The Actual Acquisition Cost (AAC) will be modified to utilize the NADAC fee schedule in the pharmacy pricing algorithm.

a. NADAC pricing will be added to the pharmacy pricing algorithm for retail and Nevada physician-administered drug (NVPAD) claims. Wholesale Acquisition Cost (WAC) is being changed from WAC +2% to WAC +0%, which will be offered for those drugs not available on NADAC.

b. The Incentive Fee Program will remain unchanged.

The above changes will have no impact on the Omnibus Budget Reconciliation Act (OBRA) of 1987 and supplemental rebate programs.

Web Announcement 958

Procedure Clarification for Targeted Case Management (TCM)

The Division of Health Care Financing and Policy (DHCFP) has identified an issue with the Health Care Guidance Program (HCGP) working with selected Targeted Case Management (TCM) beneficiaries. Since June 1, 2014, there are beneficiaries within the monthly HCGP caseload files who had/or may still be receiving services related to the Care Management Organization (CMO) and Targeted Case Management services. The HCGP may not provide services to TCM beneficiaries that are identified by searching claims data for procedure codes T1016 (Case Management) and T1017 (Targeted Case Management). These parameters were applied May 1, 2015. Any beneficiaries identified with a date of service in the previous 90 days for T1016 and T1017 are excluded from the HCGP eligible population.

Recipients who have received TCM services may be transitioned into the HCGP upon receipt of a Real Time Referral (RTR) from their targeted case management provider. This will expedite acceptance into the Health Care Guidance Program ensuring that recipients will make a smooth transition into the program. Transition into the HCGP is considered on a case-by-case basis. Referrals require a submission from a TCM entity that it will no longer provide TCM services, or will no longer bill Nevada Medicaid for TCM services, to a HCGP eligible Fee-For-Service (FFS) beneficiary. Upon enrollment verification, transition to the HCGP will begin.

It is the responsibility of the TCM service provider to ensure that billing is completed in a timely fashion for TCM services that have been provided.

  • If billing for the services has not been completed within 90 days of TCM service, then there is the possibility of services being picked up by the Care Management Organization and the provider may not bill or provide TCM services.
  • By completing the billing in a timely fashion, TCM service providers assist recipients in being picked up by the HCGP to provide CMO services in a timely manner when the recipients are not being otherwise actively managed.

Providers with questions may call the Health Care Guidance Program at (855) 606-7875, option 2, or send an email to caremanagement@dhcfp.nv.gov.

Web Announcement 957

Reminder: Password Requirements for the Provider Web Portal

Passwords must meet the following minimum requirements when they are changed or created on the Provider Web Portal:

1. Passwords cannot contain the user’s Name.

  • For example if the user’s name is John Smith, the password cannot contain the words John or Smith

2. Passwords cannot be the same as the User Id.

3. Passwords must be 8 to 20 characters.

4. Passwords must contain at least 1 character from three of the following categories:

  • Uppercase letters
  • Lowercase letters
  • Numeric digits (0 through 9)
  • Non-alphanumeric characters: ~!@#$%^&*_-+=`|\(){}[]:;"'<>,.?/

5. Passwords cannot be the same as any of the previous 24 passwords.

6. Passwords cannot be changed more than once in a 24-hour period.


Web Announcement 956

Indian Health Services Rates Adjusted for Calendar Year 2015

Rates have been adjusted for Indian Health Services effective on claims with dates of service on or after January 1, 2015. The impacted procedure codes are T1015, 99381, 99382, 99383, 99384, 99385, 99391, 99392, 99393, 99394 and 99395. The impacted revenue codes are 0100 and 0510.

Claims for the above listed codes submitted by provider types 17 (specialty 182), 47, 51, 52, 78 and 79 with dates of service on or after January 1, 2015, and processed before May 22, 2015, that paid at the previous rate were automatically reprocessed. The results of the reprocessed claims appear on remittance advices dated August 7, 2015.

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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