Attention Nursing Facility and ICF/IID Provider Types 19 and 68: Tracking Process Is Changing on July 1, 2016
[Web Announcement 1141]
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 2016 Provider Newsletter)
Web Announcement 1191
Reminder for Providers Who Have Received a Notice to Revalidate by August 31, 2016
The federal regulation at 42 CFR 455.414 requires that state Medicaid agencies revalidate the enrollment of all providers, regardless of provider types, at least every five (5) years, with the exception of DMEPOS suppliers which will remain at every three (3) years per 42 CFR 424.57. In order to comply with the Centers for Medicare & Medicaid Services (CMS) requirement for the revalidation process to be completed by September 24, 2016, the Division of Health Care Financing and Policy (DHCFP) has set a deadline of August 31, 2016.
Providers who need to revalidate by August 31, 2016, have received notices via mail. If you have received a notice to revalidate with Nevada Medicaid, please follow the instructions on the notification.
If a revalidation application is not received by the due date on the notice, the provider will be terminated from the Medicaid program on that date in accordance with 42 CFR 455 Subpart E.
If the provider contract is terminated:
- The provider will be ineligible to provide services to any Nevada Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients.
- The provider will need to submit a new enrollment application in order to participate in Nevada Medicaid and Nevada Check Up.
Provider revalidation can be completed online by accessing the Provider Web Portal or by completing a paper application. Please review the Online Provider Enrollment User Manual and Revalidation Documents located on the Provider Enrollment webpage for instructions to complete revalidation.
If you have not received a notice to revalidate, a communication will be sent when you need to take action.
Web Announcement 1190
Attention Provider Types 30 and 83: Personal Care Services (PCS) Recipients Required to Select a Single PCS or Intermediary Service Organization (ISO) Provider
Effective September 1, 2016, recipients must select a single Personal Care Services (PCS) provider agency or a single Intermediary Service Organization (ISO) for the provision of their authorized State Plan PCS hours. Division of hours between two or more agencies will no longer be allowed. Providers who currently have recipients with hours divided between two or more agencies, must notify the recipient of this change and the provider selected to perform all of the authorized hours must notify Hewlett Packard Enterprise in order for the authorization to be completed. This change becomes effective as follows:
- New and significant change assessments with authorization begin dates of September 1, 2016, or after.
- Annual reassessments: When the authorization expires September 30, 2016, or later, the change will become mandatory for each annual update at the time of their annual assessment until all recipients have a single service provider.
Web Announcement 1189
Payerpath Claim Submission Training for August 2016
The Hewlett Packard Enterprise 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.
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*All times indicated are Pacific Time (PT).
Web Announcement 1188
Attention Provider Type 25: Targeted Training Scheduled for Optometry Providers
Targeted training for provider type 25 (Optometrist) will be held on July 28, 2016, from 8:30 a.m. to 11:30 a.m. in Reno, Las Vegas, and via virtual room. This training will offer an overview of Nevada Medicaid policy by a member of the Division of Health Care Financing and Policy (DHCFP) staff, as well as information about the Nevada Medicaid program and billing guidelines for PT 25. Please visit the 2016 Nevada Medicaid Provider Training Registration Site and register to attend this training session.
Web Announcement 1187
Attention Provider Type 85: Retroactive Prior Authorization Requests for Applied Behavior Analysis (ABA) Services
Many Applied Behavior Analysis (ABA) services require prior authorization (PA). ABA providers who have not yet obtained PA for ABA services with dates of service on or after January 1, 2016, may submit retroactive PA requests until August 15, 2016.
Use form FA-11E to request authorization for services. Form FA-11F must be submitted with initial requests for ABA services along with FA-11E. PA forms are available on the Provider Forms webpage. The Provider Web Portal prior authorization system has been updated to add the Applied Behavior Analysis (ABA) authorization type to the “Authorization Type” drop-down list.
Web Announcement 1186
ICD-10 Reminders for Dental Providers Billing on the ADA Claim Form
ICD-10 is a federal mandate under Health Insurance Portability and Accountability Act (HIPAA) regulations for all HIPAA-covered entities, including but not limited to dental providers, clearinghouses, hardware/software vendors and billing agencies.
Claims with dates of service on or after October 1, 2015, must include ICD-10 codes. Please be sure that claims submitted on the paper American Dental Association (ADA) claim form include the appropriate diagnosis code pointer(s) in Field 29a, and the appropriate diagnosis code(s) in Field 34a per the ADA (Version 2012) Claim Form Instructions. Claims submitted electronically through your clearinghouse must follow the instructions listed in the Transaction 837D - Dental Health Care Claim - HIPAA Version 5010 companion guide. Incorrectly submitted claims will be denied.
Web Announcement 1185
Urgent Notice for Providers Using Change Healthcare Clearinghouse to Submit Professional and Institutional Claims
Processing may be delayed on claims submitted June 30, 2016, through July 8, 2016, using the Change Healthcare clearinghouse. Professional (5111) and Institutional (5216) claims may be impacted. Hewlett Packard Enterprise is working on a resolution to reduce any delay in payment for providers using this clearinghouse. Please refer to your remittance advice dated July 15, 2016, for further details. For any questions you may have, please call the Hewlett Packard Enterprise Customer Service Center at (877) 638-3472.
Web Announcement 1184
Update for Provider Types 24 and 77: Radiology Claims to be Reprocessed
Update to Web Announcement 1120: Claims for radiology codes (70000-79999) submitted by provider types 24 (Advanced Practice Registered Nurses) and 77 (Physician’s Assistant) are no longer denying inappropriately for edit codes 0309 (Services not covered) and/or 0148 (Rendering provider not certified to perform procedure) beginning April 18, 2016. Claims for these codes submitted by PT 24 and 77 with dates of service on or after January 1, 2016, through claims processed before April 18, 2016, that denied for edit codes 0309 and/or 0148 are being automatically reprocessed. The results of the reprocessed claims appear on remittance advices dated July 15, 2016.
Web Announcement 1183
2016 Nevada Medicaid Provider Survey Results
During the first quarter of 2016, Nevada Medicaid invited providers to offer feedback and rate their overall experience with Medicaid. The results have been compiled and are published on the www.medicaid.nv.gov website on the Provider Training webpage. Providers were given an opportunity to give their direct comments and feedback as well as respond to questions. Here’s what some providers said about Nevada Medicaid in response to a request for feedback on “Things Going Well”:
- “Overall customer service is great.”
- “Much improved service versus 8 years ago. Bravo!”
- “HP has done an excellent job of updating the Medicaid system and helping providers keep up with the changes. It is getting easier.”
Providers that participated in the survey also offered important feedback on “Suggestions for Improvement” to enhance their experience. An area providers were passionate about was the Provider Web Portal. Providers want to see enhancements to the portal that include updates around prior authorizations, ability to submit claim appeals online, and a place to report third party liabilities. The enhancements would give providers the accessibility they are looking for while continuing to focus on a better experience with Nevada Medicaid.
The survey also asked participants to rate their overall experience from the claim adjudication process to customer service. Results indicated providers are satisfied with their overall experience, but offered suggestions for improvement. These suggestions are being implemented in call center training programs, provider field representative communications, and future enhancements to the claim submission process.
Provider feedback is critical to a successful Medicaid program. The 2016 Nevada Provider Survey results yielded useful insight to the provider community’s overall experience with Nevada Medicaid. As the program continues to grow, so will the outreach efforts to gain feedback from the providers. Please take a moment to review the results of the 2016 Provider Survey and reach out to Hewlett Packard Enterprise if you have any questions. Hewlett Packard Enterprise staff looks forward to provider comments and participation in the 2017 survey.