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Urgent Notification

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

Latest News

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]

Attention Applied Behavior Analysis Providers: Training Sessions Scheduled for Providers Interested in Enrolling as a Nevada Medicaid ABA Provider [Web Announcement 916]

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

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

Web AnnouncementsView All

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: 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 July 7 7 to 8 a.m.
ADA Wednesday July 8 7 to 8 a.m.
CMS-1500 Tuesday July 14 7 to 8 a.m.
UB Wednesday July 15 7 to 8 a.m.
CMS-1500 Wednesday July 22 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:

Northern Nevada
DWSS – Carson City District Office
2533 N. Carson St.
Carson City, NV 89706
Southern Nevada
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 ashley.barton@dhcfp.nv.gov.

Web Announcement 930

Coming Soon: Secure Submission of Forms Using the Provider Web Portal

HP Enterprise Services (HPES) is currently updating the Nevada Medicaid forms that are available online on the Providers Forms webpage at https://www.medicaid.nv.gov/providers/forms/forms.aspx. These forms will be updated to a format that will allow the forms to be completed, downloaded and saved electronically. Most of the forms will be able to be submitted securely to HPES using the Provider Web Portal instead of printing and faxing. Future web announcements on this website will notify providers of the implementation date for this enhancement, which forms are affected and instructions for submitting the forms online.

Web Announcement 929

Attention Provider Types 10 and 46: Update Regarding the All-Inclusive Reimbursement for BAHA, Cochlear, VNS, and Baclofen Pump

Please disregard Web Announcements 399 and 557. This web announcement contains updated information.

Nevada Medicaid has established an all-inclusive reimbursement rate for provider types (PT) 10 (Outpatient Surgery-Hospital Based) and 46 (Free-Standing Ambulatory Surgical Centers) for the Bone-Anchored Hearing Aid (BAHA), Cochlear, Vagus Nerve Stimulator (VNS), and Baclofen Pump surgical implant services. The established all-inclusive facility reimbursement rate includes the Healthcare Common Procedure Coding System (HCPCS) device, and all associated services for the Ambulatory Surgical Centers (ASC) payment group for the Current Procedural Terminology (CPT) surgical procedure.

To receive the all-inclusive reimbursement rate for the surgical implant procedures listed below, the facility is required to obtain a prior authorization (PA) from Medicaid’s QIO-like vendor (HP Enterprise Services), and for PT 10 only, a letter of agreement (LOA) from the Division of Health Care Financing and Policy (DHCFP). The PA will identify the CPT code authorized. The LOA will be issued by DHCFP, and will identify the following: provider name and National Provider Identifier (NPI); recipient name and Medicaid identification number; and the established all-inclusive facility reimbursement rate for the procedure. Medicaid will not provide an LOA until/unless a PA has been issued to the facility by HP Enterprise Services.

In order for claims for these services to adjudicate and reimburse correctly, follow the instructions below according to the type of facility:

  • PT 10 must bill using the UB-04 claim form, with the appropriate CPT code in Field 44.
  • PT 46 must bill using the CMS-1500 claim form, using the appropriate CPT code in the required Field 24D (Procedures, Services, or Supplies CPT/HCPCS Modifier) and the corresponding dollar amount from the table below, in the required Field 24F ($ Charges). Bill all other services rendered on the same day in conjunction with the surgical code on single lines in Field 24D and zero dollar amount in Field 24F due to the all-inclusive rate.

The following table displays the CPT code and the established all-inclusive facility reimbursement rate for PTs 10 and 46:

Service CPT code Description All-indusive facility rate
Cochlear 69930 Cochlear Device Implantation, with or without mastoidectomy $19,426.50
BAHA 69714
69715
BAHA Device Implantation: without mastoidectomy
BAHA Device Implantation: with mastoidectomy
$8,324.50
$8,324.50
BAHA 69717
69718
Replacement (including removal of existing device): without mastoidectomy
Replacement (including removal of existing device): with mastoidectomy
$8,324.50
$8,324.50
VNS 61885
61886
64568
Insert cranial nerve neurostimulator; connect to single electrode array
Insert cranial nerve neurostimulator; connect to 2 or more arrays
Incision for implantation of cranial nerve neurostimulator electrode array and pulse generator
$19,884.00
$25,551.00
$25,551.00
Baclofen Pump 62361
62362
Implant spine infusion pump (nonprogrammable pump)
Implant spine infusion pump (programmable pump)
$6,515.00
$10,603.00

The above listed services are not reimbursed to PT 12.

Reference Medicaid Services Manual (MSM) Chapter 200, Section 203.5, and Chapter 600, Section 603.10 Physician Services In Outpatient Setting, for Cochlear Implant, BAHA System Implant, VNS and Baclofen Pump policy related to PTs 10 and 46.

For complete Cochlear and BAHA System Implant policy, refer to the Medicaid Services Manual (MSM) Chapter 2000, Coverage and Limitations, and Chapter 600, Section 600.10 Physician Services In Outpatient Setting.

The physician/surgeon (PT 20) is required to obtain a separate PA for the CPT surgical procedure code.

Web Announcement 928

ICD-10 Testing and Facts Information

As Nevada Medicaid approaches the ICD-10 implementation on October 1, 2015, trading partners and providers are asking about testing with Nevada Medicaid. Trading partners and providers who are interested in testing ICD-10 claim transactions may contact HP Enterprise Services (HPES) at nvicd10testing@hp.com and HPES will send additional testing information. Testing will begin in late June/early July. Trading partners and providers are 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.

Providers who use a clearinghouse to submit claims are encouraged to contact their clearinghouse to make sure they test with HPES prior to the mandated date for ICD-10.

ICD-10 Facts

  • 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
  • Mandatory compliance date October 1, 2015

Web Announcement 927

June Provider Training Sessions Scheduled in Elko and Onsite Visits in Elko and Winnemucca

Training sessions are scheduled throughout the day on Thursday, June 25, 2015, in Elko, NV., for currently enrolled Nevada Medicaid providers and providers who are considering enrolling as a Nevada Medicaid provider.

An HP Enterprise Services (HPES) Provider Services Field Representative will present all sessions at the Elko Hilton Gardens Hotel located at 3650 E. Idaho St., Elko, NV 89801. The following sessions will be held in the Humboldt 1 room on the ground floor:

Session 1 8:30 a.m. – 10 a.m. New Innovations for Medicaid Providers
(System tools to assist currently enrolled providers with their Medicaid recipients)
Session 2 10:30 a.m. – noon Medicaid: Back-to-Basics Billing on the CMS-1500 Claim Form
(Billing, special batching, and adjustments and voids for currently enrolled providers)
Session 3 1 p.m. – 2:30 p.m. How to Become a Medicaid Provider
(Medicaid guidelines and the enrollment process for those who are considering enrolling as a Nevada Medicaid provider)

Providers may register for the above sessions at: https://starcite.smarteventscloud.com/rsvp/invitation/invitation.asp?id=/m1c9c3a7-52QK5QUTQ0HHC or go to www.medicaid.nv.gov and select “Provider Training” from the “Providers” tab, then click on “2015 Provider Training Registration Website.”

Your Provider Field Representative, Kim Teixeira, will also be in Winnemucca on Monday, June 22, for onsite visits to providers and then in Elko on Tuesday and Wednesday, June 23-24, for onsite visits. If you would like to schedule an onsite visit with your Field Representative, please send an email to Kim.nal.teixeira@hp.com to schedule a date and time.

Web Announcement 926

Provider Type 33 Claims that Denied for Edit Code 0325

Claims submitted by provider type 33 (DME, Prosthetics, Orthotics and Disposable Medical Supplies) for procedure codes using modifiers RB (Replacement and Repair) or MS (6 month maintenance and service) in the same month as a claim with a different procedure with modifier RR (DME Rental) that denied inappropriately with edit code 0325 (Deny RB/MS modifier with RR paid) will be reprocessed.

An example of an affected claim that denied inappropriately has a power wheelchair component rental and a nebulizer rental within the same month. The affected claims have dates of service on or after January 1, 2011, through claims processed on or before September 12, 2012. The results of the reprocessed claims will be reflected on remittance advices dated June 12, 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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