Attention Provider Type 85: Retroactive Prior Authorization Requests for Applied Behavior Analysis (ABA) Services
[Web Announcement 1187]
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 1193
Attention Provider Type 20: Update Regarding Pediatric Surgery Enhancement Rates
Update to Web Announcement 1130: Claims for pediatric surgical services codes 30000-39999 billed by provider type (PT) 20 (Physicians) with modifiers and dates of service on or after January 1, 2016, are paying the pediatric enhancement rate correctly on claims processed on or after July 12, 2016. Claims for pediatric surgical services codes 30000-39999 billed by PT 20 without modifiers and dates of service on or after January 1, 2016, are paying the pediatric enhancement rate correctly on claims processed on or after April 18, 2016.
Claims submitted by PT 20 for pediatric surgical codes 30000-39999 with dates of service on or after January 1, 2016, that processed before April 18, 2016, (without modifiers) or before July 12, 2016, (with modifiers) and paid at the regular rate will be automatically reprocessed. A future web announcement will notify providers when the claims will be reprocessed.
Web Announcement 1192
Claims for CPT Code 95811 No Longer Denying Inappropriately for Edit Code 1192
Effective June 21, 2016, claims for Current Procedural Terminology (CPT) code 95811 (Age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) with a prior authorization (PA) on file to exceed limitation will no longer deny inappropriately for edit code 1192 (Two service units per 12 months).
The affected claims with dates of service on or after September 1, 2014, through claims processed before June 21, 2016, that denied inappropriately will be automatically reprocessed. A future web announcement will notify providers when the affected claims are reprocessed.
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: 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).