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 1077
Narcan Nasal Spray Added to Preferred Drug List
Effective February 22, 2016, Narcan Nasal Spray will be listed as preferred on the Nevada Medicaid/Nevada Check Up Preferred Drug List (PDL). This medication is currently available without prior authorization.
Narcan Nasal Spray is an opioid antagonist indicated for the emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression. Narcan Nasal Spray is intended for immediate administration as emergency therapy in settings where opioids may be present.
Narcan Nasal Spray is not a substitute for emergency medical care.
Narcan (naloxone hydrochloride) nasal spray package insert. Radner, PA: Adapt Pharma, Inc.; 2015 Nov.
Web Announcement 1076
Clinical Claim Editor Updated with NCCI Quarter 1 2016 Files
The clinical claim editor in the Medicaid Management Information System (MMIS) will be updated on February 15, 2016, with the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Quarter 1 2016 files, which were effective January 1, 2016.
Claims processed on or after January 1, 2016, through February 14, 2016, that were not processed using the updated NCCI files will be automatically reprocessed. The results of the reprocessed claims will appear on a future remittance advice.
Web Announcement 1075
Attention All Providers: Recipients Will Receive Form 1095-B Regarding Medicaid Coverage
Form 1095-B Health Coverage will be mailed to Nevada Medicaid/Nevada Check Up recipients no later than February 29, 2016. Recipients of the Nevada Medicaid/Nevada Check Up program may need the Form 1095-B Health Coverage information when they file their 2015 federal tax return. The forms will be mailed to the head of household only, and the forms will list each of the Nevada Medicaid/Nevada Check Up recipients within the household. For more information regarding the Affordable Care Act’s tax implications, visit: www.irs.gov/Affordable-Care-Act/Individuals-and-Families.
Web Announcement 1074
Reminders for Provider Type 63 (RTC) Regarding Prior Authorization Requests for Concurrent Reviews
Residential Treatment Center (RTC) providers are reminded to submit authorization requests for concurrent review with an accurate start date. It is the provider’s responsibility to provide accurate and complete information. Inaccurate or incomplete information can result in a delay or technical denial.
- The requested start date for a concurrent review should be the day after the previous authorization treatment period ends.
- Be sure the request does not have overlapping dates of service or unplanned lapses in service between the two authorization treatment periods.
- A concurrent review should be submitted 5 to 15 business days prior to the end of the previous authorization treatment period.
- Use form FA-13 for Residential Treatment Center concurrent reviews. Enter the date of admission, number of RTC days and requested start date in section VI of the form:
Web Announcement 1073
Provider Revalidation Requirement Extension
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. Federal regulation required all providers to complete the revalidation process by March 24, 2016.
The Centers for Medicare & Medicaid Services (CMS) has revised the previous guidance to now require a two-step deadline under which states must notify all affected providers of the revalidation requirement by the original March 24, 2016 deadline, and must have completed the revalidation process by September 24, 2016. In order to comply with the CMS requirement for the revalidation process to be completed by September 2016, the Division of Health Care Financing and Policy (DHCFP) has set a deadline of August 31, 2016.
If you have received a notice to revalidate with Nevada Medicaid, please follow the instructions on the notification. If you have not received a notice to revalidate, a communication will be sent when you need to take action. Providers that fail to respond to revalidation must be terminated in accordance with 42 CFR 455 Subpart E.
Future web announcements and communications to providers will provide additional instructions and updates regarding Nevada Medicaid revalidation requirements.
For additional information, please see Web Announcement 450 (published on February 15, 2012), which notified providers of the revalidation process that began June 1, 2012.
Web Announcement 1072
Provider Type 60 (School Based) Claims for Procedure Code 92523 with Modifier 52
Effective on claims processed on or after December 21, 2015, claims submitted by provider type 60 (School Based) for procedure code 92523 (Evaluation of speech sound production) no longer deny with edit code 0210 (No fees found on file) when billed with modifier 52. PT 60 claims for code 92523 with modifier 52 with dates of service on or after January 1, 2014, through claims processed before December 21, 2015, that previously denied with edit code 0210 will be automatically reprocessed. The results of the reprocessed claims will be reflected on a future remittance advice.
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.