Web Announcement 991
Provider Type 11 Rate Increase
Effective on claims with dates of service on or after July 9, 2015, provider type 11 (Hospital, Inpatient) rates have been increased for medical/surgical, maternity, newborn and administrative day stays. Claims with dates of service on or after July 9, 2015, that paid at the previous rate will be automatically reprocessed. The results of the reprocessed claims will appear on a future remittance advice.
Rates are available on the Provider Web Portal at www.medicaid.nv.gov through the Search Fee Schedule function, which can be accessed on the EVS Login webpage under Resources (you do not need to log in).
Web Announcement 990
Attention Behavioral Health Provider Types 14, 17, 26, 63 and 82: The Prior Authorization Forms Revised for ICD-10 Codes Must Be Used
Update to Web Announcement 973: The following prior authorization (PA) forms have been revised to incorporate the use of ICD-10 Primary, Secondary and Tertiary Codes and corresponding Disorders. The sections requesting DSM Diagnosis Code and Narrative information have been removed.
- FA-11: Outpatient Mental Health Request
- FA-11A: Behavioral Health Authorization Request
- FA-11D: Substance Abuse/Behavioral Health Authorization Request
- FA-12: Inpatient Mental Health Prior Authorization
- FA-13: Residential Treatment Center Concurrent Review
- FA-14: Inpatient Mental Health Services Concurrent Review Request
- FA-15: Residential Treatment Center Prior Authorization
The revised PA forms are now online and must be used for requests submitted on or after October 1, 2015, regardless of date of service. HP Enterprise Services will not process requests for review that are received on an outdated form. Requests submitted on an outdated form will be returned to the provider. The forms are available on the Providers Forms webpage at www.medicaid.nv.gov.
The diagnosis section of the outdated forms request the following information:
The revised forms effective October 1, 2015, request the ICD-10 Primary, Secondary and Tertiary codes and the corresponding Disorders as shown below:
Web Announcement 989
Attention Provider Types 11, 13, 19, 44, 56, 63 and 75: Billing and Prior Authorization Instructions for Claims that Span from a Previous Month through October 2015
For inpatient hospital claims (provider types 11, 13, 19, 44, 56, 63 and 75) with dates of service that span from a previous month through October 2015 with the discharge date on or after October 1, 2015, the entire claim should be billed using ICD-10 codes. Inpatient hospital providers are not required to split bill these claims.
For inpatient hospital prior authorization requests (provider types 11, 13, 19, 44, 56, 63 and 75) with dates of service that span from a previous month through October 2015:
- Use ICD-9 codes for PAs with dates of service with a through date prior to October 1, 2015.
- Use ICD-10 codes for PAs with dates of service with a through date on or after October 1, 2015.
Web Announcement 988
Special Batch Requests for Inpatient Newborn Claims that Denied because Eligibility Changed from Managed Care Organization to Fee-for-Service after Date of Birth
Inpatient hospital providers can request special batch re-processing of newborn claims with dates of service from May 1, 2013, through May 31, 2015, originally submitted within timely filing limits, but inappropriately denied for no prior authorization due to a change in eligibility from Managed Care Organization (MCO) to Fee-for-Service (FFS) after a newborn’s date of birth. These claims must be received by HP Enterprise Services by October 30, 2015, to be eligible for reimbursement.
Providers can also request special batch re-processing of newborn claims with dates of service after May 31, 2015, inappropriately denied for no prior authorization due to a change in eligibility from MCO to FFS after a newborn’s date of birth as long as the original claim submission and special batch reprocessing request are submitted within timely filing limits.
For all claims mentioned above, providers must submit to the attention of the HP Enterprise Services Customer Service Unit a paper claim with a cover letter referencing this Web Announcement 988 and request special batch processing. In order to be reimbursed, the affected claims must meet all of the following criteria:
- A newborn’s eligibility changed from MCO to FFS after the date of birth during the initial inpatient episode of care;
- Inpatient newborn days were billed with revenue codes 0170, 0171 or 0172;
- Diagnosis codes on the claim are for a vaginal or Cesarean section delivery;
- Newborn inpatient days do not exceed three days related to a vaginal delivery or four days related to a Cesarean section delivery; and
- The claim denied for no prior authorization.
Web Announcement 987
ICD-10 Implementation is in Two Days on October 1, 2015
The implementation of the ICD-10 code sets is this week, on Thursday, October 1, 2015. Please be sure you and your clearinghouse are ready to bill claims with ICD-10 codes. Claims with dates of service on or after October 1, 2015, must use ICD-10 codes. ICD-9 codes must be used on claims with a date of service prior to October 1, 2015. If ICD-9 codes are used with a date of service on or after October 1, 2015, the claims will be denied. See Web Announcement 976 for prior authorization and billing tips.
Web Announcement 986
Attention Provider Type 83: Use New, All-Inclusive Form FA-24C to Request Authorization for Self-Directed Skilled Services
A new, all-inclusive form has been published for provider type 83 (Personal Care Services – Intermediary Service Organization) to request authorization for self-directed skilled services. Form FA-24C (Authorization Request for Self-Directed Skilled Services) is online now for use beginning October 1, 2015. The previous forms for self-directed services (see list below) may be used only until October 31, 2015. Effective November 1, 2015, requests for self-directed skilled services submitted on any form other than the new FA-24C will be returned. The new FA-24C and FA-24C Instructions are posted on the Provider Forms webpage at www.medicaid.nv.gov.
For the purposes of an authorization request for self-directed skilled services only, the new, all-inclusive form FA-24C (Authorization Request for Self-Directed Skilled Services) replaces ALL of the following forms:
- FA-24: Authorization Request for Personal Care Services (PCS) (Note: FA-24 is still a valid form for the purposes of requesting Personal Care Services)
- NMO-3245: Intermediary Service Organization (ISO) Self-Directed Specific Skilled Medical, Nursing, or Home Health Care Services Recipient Agreement
- NMO-3246: Intermediary Service Organization (ISO) Self Directed Specific Skilled Medical, Nursing, or Home Health Care Services Personal Care Representative (PCR) Agreement
- NMO-3426: Nevada Medicaid Personal Care Services Program Self Directed Specific Medical, Nursing or Home Health Care Services Criteria
- NMO-3427: Nevada Medicaid Provider Agreement for Provision of Self Directed Specific Medical, Nursing or Home Health Care Services
- NMO-3428A: Health Care Provider Authorization for Self Directed Specific Medical, Nursing or Home Health Care Services
- NMO-3428B: Training Health Care Provider Authorization
- NMO-3429E: Nevada Medicaid Health Care Provider’s Letter of Explanation
Web Announcement 985
Payerpath Claim Submission Training for October 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 984
“One Medicaid for a Healthier Nevada” Annual Medicaid Conference
Health care professionals are highly encouraged to attend the Annual Medicaid Conference that will provide education and information on how Nevada Medicaid/Nevada Check Up providers, the Nevada Division of Health Care Financing and Policy (DHCFP) and HP Enterprise Services can work together to make a healthier Nevada.
Topics planned to be included are:
- Forward Vision for a Healthier Nevada
- Legislative Updates
- Break and time to visit vendor booths
- Nevada's State Innovation Model (SIM)
- Policy Updates from the Division of Welfare and Supportive Services
- Partner Introductions
- HP Enterprise Services
- Health Plan of Nevada
- Health Care Guidance Program
- Policy Updates from the Division of Health Care Financing and Policy
- Program Integrity
Conference 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 a morning and afternoon session at each location, and the content will be the same in each session.
- Registration for the morning sessions will be from 7:30-8:00 a.m., with the conference running from 8 to 11:50 a.m.
- Registration for the afternoon sessions will be from 12:30-1:00 p.m., with the conference running from 1 to 4:50 p.m.
There will be time to visit vendor booths after registration and at the end of each session.
Registration is required to attend the conference; please visit 2015 Annual Medicaid Conference (http://starcite.smarteventscloud.com/hp/Annual_Medicaid_NV2015) for the agenda and to register for the session of your choice.
Remember: Please print and bring your registration confirmation with you to the conference.
Like last year's event, the 2015 Medicaid Conference will be "green." The presentations will not be printed and distributed; instead, they will be available for downloading and printing from the Provider Training webpage at http://www.medicaid.nv.gov/providers/training/training.aspx following the conference.
Web Announcement 983
Human Papillomavirus (HPV) Laboratory Testing Codes 87623, 87624 and 87625
Effective on claims with dates of service on or after January 1, 2015, the following CPT codes can be used for Human Papillomavirus (HPV) Laboratory Testing: 87623, 87624 and 87625. The three codes replace CPT code 87621, which can no longer be billed effective on claims with dates of service on or after December 31, 2014. Affected provider types are 12, 17 (specialties 174, 183, 195, 196, 197, 198), 20, 21, 24, 43, 72, 74 and 77.
Claims submitted by the above listed provider types for CPT codes 87623, 87624 and 87625 with dates of service on or after January 1, 2015, through July 24, 2015, that denied will be automatically reprocessed. The results of the reprocessed claims will appear on a future remittance advice.
Web Announcement 982
Pharmacy Dispensing Fee Increase and Pricing Methodology Using National Average Drug Acquisition Cost (NADAC) Files
Effective November 1, 2015, Nevada Medicaid will increase the professional dispensing fee and implement 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.
The professional dispensing fee for outpatient and retail pharmaceuticals will be increased.
- The State’s dispensing fee for all outpatient retail pharmacies is increasing from $4.76 to $10.17 per prescription.
- IV therapy and long term care (LTC) will receive the same dispensing fee as the retail pharmacies; per policy their rate will be daily.
- The dispensing fee for supplies, including diabetic supplies, will remain unchanged.
The Actual Acquisition Cost (AAC) will be modified to utilize the NADAC fee schedule in the pharmacy pricing algorithm.
- 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.
- 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.