DHCFP Notice of Town Hall and Listening Sessions on Medicaid Managed Care Expansion Options on January 20, February 2, February 17 and February 19
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 (Fourth Quarter 2015 Provider Newsletter)
Provider Web Portal Quick Reference Guide (Updated April 16, 2012) [Review]
Web Announcement 1071
Attention Provider Type 33 (Durable Medical Equipment): Data Correction Instructions Related to DME Ventilator Code Changes Effective January 1, 2016
Follow-up to Web Announcement 1063: Provider type 33 (Durable Medical Equipment) providers who have an approved prior authorization for HCPCS codes E0450, E0460, E0461, E0463 and E0464 for dates of service January 1, 2016, or greater will need to submit a Prior Authorization Data Correction Form (FA-29) to have approved units moved to the replacement code.
If the current prior authorization is for E0461 for dates of service 02/28/15 through 2/28/16 for 12 units,
And dates of service 02/28/15 through 12/31/15 used 10 units,
Then submit FA-29 for dates of service 01/01/16 through 02/28/16 for 2 units with the appropriate new code (E0456 or E0466).
For questions regarding prior authorizations and data corrections, please call (800) 525-2395. For questions regarding claims and billing, please call (877) 638-3472.
Web Announcement 1070
Nevada Medicaid Website Maintenance Downtime
On Saturday, February 13, 2016, beginning at 10:00 p.m. PT, Nevada Medicaid will be performing maintenance that will impact the Provider Web Portal, Audio Response System (ARS), PASRR and EDI services. This is a 4-hour maintenance window and is expected to be completed by 2:00 a.m. PT Sunday, February 14, 2016. During this 4-hour window, you will not be able to use the following services:
- All website content
- Electronic Verification System (EVS)
- Online prior authorization system
- Pharmacy Web PA
- EHR Incentive Program
- Audio Response System (ARS) (800-942-6511)
- Online Provider Enrollment
- Batch and Real-Time 270/271 Eligibility Electronic Transactions
- 837 Electronic Health Care Claim Transactions
Web Announcement 1069
Attention Provider Types 10, 29, 45, 46 and 81: Search Fee Schedule Updated on the Provider Web Portal
On January 31, 2016, an enhancement was made to the Search Fee Schedule application to allow provider type (PT) 10 (Outpatient Surgery, Hospital Based), PT 29 (Home Health Agency), PT 45 (ESRD Facility), PT 46 (Ambulatory Surgical Centers) and PT 81 (Hospital Based ESRD Provider) to search for fees on the Provider Web Portal. Please see the full Web Announcement 1069 and Electronic Verification System (EVS) User Manual Chapter 6: Search Fee Schedule for instructions.
Web Announcement 1068
ICD-10 “Z” Codes and “O09” Codes Billed as the Primary/Principal/First-Listed Diagnosis Will No Longer Deny Effective February 15, 2016
Update to Web Announcement 1046: All ICD-10 “Z” encounter diagnosis codes and the “O09” family of supervision of high-risk pregnancy diagnosis codes will be updated in the Medicaid Management Information System (MMIS) on February 15, 2016. Claims for these codes processed on or after February 15, 2016, will no longer deny when billed as primary/principal/first-listed diagnosis codes.
A future web announcement will notify providers when affected claims that denied inappropriately will be automatically reprocessed.
Web Announcement 1067
New File Type Requirements When Uploading Forms Online
As of January 31, 2016, only the following file types will be allowed when submitting forms online using the “Upload Files” page on the Provider Web Portal.
- .doc .docx .pdf .bmp .gif .png .jpg .jpeg .tif .xls .xlsx .txt .zip and .efx
Web Announcement 1066
Provider Web Portal Enhancement: Treatment History Search for DME, Vision, Audiology and Dental Provider Types
On January 31, 2016, the Treatment History search feature will be added to the Provider Web Portal. This feature can be used to view claim history for DME, Vision, Audiology and Dental procedures that have limitations. The online Treatment History search can be used instead of the paper Durable Medical Equipment (DME) and Vision History Request (FA-2) and Dental History Request (FA-26A) forms.
Providers with a provider type of DME, Vision, Audiology or Dental can use Treatment History to view a list of the paid claim information for the search criteria entered. Up to twenty (20) results are returned at a time, with the most current dates of service listed first. If more than 20 claims exist, paging is available.
Please review the full Web Announcement 1066 and the new EVS User Manual Chapter 9: Treatment History for instructions on accessing Treatment History search and the explanations for error messages.
Web Announcement 1065
ICD-10 Diagnosis Code O80 Added to “ICD-10-CM Emergency Diagnosis Codes for Non-U.S. Citizens with Emergency Medical Only Coverage” List
ICD-10 diagnosis code O80 (Encounter for full-term uncomplicated delivery) has been added to the “ICD-10-CM Emergency Diagnosis Codes for Non-U.S. Citizens with Emergency Medical Only Coverage” list. This list is online on the Prior Authorization Procedure and Diagnosis Reference Lists webpage at www.medicaid.nv.gov.
Code O80 has been added to the claims processing system and will no longer deny effective with claims processed on or after January 25, 2016. Code O80 can be billed effective with dates of service on or after October 1, 2015. Claims for code O80 with dates of service October 1, 2015, through claims processed before January 25, 2016, that denied with edit code 0450 (Non-emergency services not authorized for non-citizens) will be automatically reprocessed. The results of the reprocessed claims will be reflected on a future remittance advice.
Web Announcement 1064
Urgent Announcement for Provider Types 85 and 20 Providing Applied Behavior Analysis Services
The Applied Behavior Analysis (ABA) procedure codes listed below will deny with edit code 0309 (Service not covered) until they are updated in the Medicaid Management Information System (MMIS), upon approval from the Centers for Medicare & Medicaid Services (CMS). Please submit your claims as usual even though they will deny. You do not need to resubmit the claims after they deny, because the affected claims will be automatically reprocessed. Providers will be notified in future web announcements when the codes are updated and will no longer deny, and when the claims will be reprocessed.
The affected ABA procedure codes are:
Web Announcement 1063
Urgent Announcement for Provider Type 33: DME Ventilator Code Changes Effective January 1, 2016
The HCPCS codes used by provider type (PT) 33 (DME) to bill for ventilators have changed effective January 1, 2016.
HCPCS codes E0450, E0460, E0461, E0463 and E0464:
- Effective with dates of service on or after January 1, 2016, HCPCS codes E0450, E0460, E0461, E0463 and E0464 have been discontinued by the Centers for Medicare & Medicaid Services (CMS) and are no longer accepted by Nevada Medicaid for DME.
- Claims for E0450, E0460, E0461, E0463 and E0464 with dates of service on or after January 1, 2016, will deny. Previously submitted claims for these codes with a date of service on or after January 1, 2016, that denied need to be resubmitted with the new codes: either E0465 or E0466. This should be done after the provider has requested a data correction to change the prior authorization to the new code.
- If you have an approved prior authorization for E0450, E0460, E0461, E0463 or E0464 with dates of service including January 1, 2016, and greater, you will need to send a Prior Authorization Data Correction Form (FA-29) to Hewlett Packard Enterprise to request the January 1 and greater dates of service be changed to code E0465 or E0466. An upcoming web announcement will provide detailed instructions.
- Effective with dates of service on or after January 1, 2016, prior authorization requests need to use E0465 or E0466.
Please note: Claims for codes E0465 and E0466 will deny until the codes are updated in the system. Please submit your claims as usual even though they will deny. You do not need to resubmit the claims after they deny, because the affected claims will be automatically reprocessed. Providers will be notified in future web announcements when the codes are updated and will no longer deny, and when the claims will be reprocessed.
If the claim denials resulting from these changes create a financial hardship, PT 33 providers may request advance payments by sending an email to Hewlett Packard Enterprise at NevadaProviderTraining@hpe.com. Enter “Advance Payment Request/Financial Hardship” in the subject line and include in the email: the amount of the advance requested; the reason for the request; the provider’s National Provider Identifier (NPI) under the PT 33 designation; and the provider’s name, address and telephone number. Please allow several business days for the request to be processed.
Web Announcement 1062
2016 Nevada Medicaid Provider Survey
All Nevada Medicaid providers are invited to complete the 2016 Nevada Medicaid Provider Survey. The survey has been developed to gain your feedback, which will assist the Division of Health Care Financing and Policy (DHCFP) and Hewlett Packard Enterprise in improving your overall experience as an enrolled Nevada Medicaid provider and to better serve you in the future.
Please take a few moments to complete the survey available at the following link: https://www.surveymonkey.com/r/FGCS35K
The survey is open from January 25, 2016, to February 29, 2016.
Web Announcement 1061
Attention Provider Type 29: Data Correction Instructions Related to Skilled Nursing Code Changes Effective January 1, 2016
Follow-up to Web Announcement 1059: Provider type 29 (Home Health Agency) providers who have an approved prior authorization for HCPCS code G0154 for dates of service January 1, 2016, or greater will need to submit a Prior Authorization Data Correction Form (FA-29) to have approved units moved to the replacement code.
Replacement code crosswalk:
- G0154 crosswalked to G0299
If the current prior authorization is for G0154 for dates of service 11/01/15 through 2/28/16 for 988 units,
And dates of service 11/01/15 through 12/31/15 used 493 units of G0154,
Then submit FA-29 for dates of service 01/01/16 through 02/28/16 for 495 units to G0299.
- If your current authorization is under T1003, please bill code T1003 until the authorization expires. A data correction is not required.