Web Announcement 968
Uses for the “ICD-9-CM Emergency Diagnosis Codes for Non-U.S. Citizens with Emergency Medical Only Coverage” List
The “ICD-9-CM Emergency Diagnosis Codes for Non-U.S. Citizens with Emergency Medical Only Coverage” document is a list of ICD-9-CM diagnoses codes for which emergency medical services are covered by Nevada Medicaid for non-U.S. citizens eligible for emergency medical only coverage. This includes the provision of outpatient emergency dialysis through the Federal Emergency Services Program (FESP). For outpatient emergency dialysis FESP policy information, please see Medicaid Services Manual (MSM) Chapter 200, Attachment A. Medical services for treatment of the diagnosis codes on the list are not reimbursed for non-U.S. citizens eligible for emergency medical only coverage when associated with non-emergent medical services or once the emergency medical condition is stabilized. The Social Security Act, Section 1903 (v) (3) - Payment to States and 42 CFR 440.255 - Limited services available to certain aliens, preclude Medicaid reimbursement of non-emergency services for non-U.S. citizens eligible for emergency medical only coverage.
The “ICD-9-CM Emergency Diagnosis Codes for Non-U.S. Citizens with Emergency Medical Only Coverage” document is available at https://www.medicaid.nv.gov/providers/priorauth/referencelists.aspx.
Web Announcement 967
It’s 1 month until ICD-10 Codes Must Be Used on Claims with Dates of Service on or after October 1, 2015. Have You Tested to Ensure Claims will be Accepted and Processed?
The last day to submit your ICD-10 test file(s) will be on September 14, 2015. If you haven’t done so, HP Enterprise Services (HPES) highly encourages all trading partners and providers test prior to the federal mandate date for ICD-10, which is for claims with dates of service on or after 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, which could potentially have negative impacts on provider payments.
Providers: Please reach out to your clearinghouse to request they coordinate a test run with HPES to ensure that your claim submissions with dates of service on or after October 1, 2015, can be accepted and processed.
HP Enterprise Services (HPES) has posted useful ICD-10 Frequently Asked Questions on the Provider Billing Information webpage at: https://www.medicaid.nv.gov/providers/BillingInfo.aspx.
HPES has started ICD-10 Trading Partner Testing. Testing instructions and an end-to-end testing schedule are posted on the Providers Electronic Claims/EDI webpage at https://www.medicaid.nv.gov/providers/edi.aspx. Please take time to look over this information as well as the FAQs. If you have any questions, or would like to participate in ICD-10 testing, you may contact HPES at email@example.com.
- ICD-9 codes must contain dates of service before October 1, 2015
- ICD-10 codes must contain dates of service on or after October 1, 2015.
- 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
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
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.
7 to 8 a.m.
7 to 8 a.m.
7 to 8 a.m.
7 to 8 a.m.
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
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.