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Notification

Provider Web Portal Enhancement: Treatment History Search for DME, Vision, Audiology and Dental Provider Types [Web Announcement 1066]

Latest News

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 (First Quarter 2016 Provider Newsletter) [Read]

Web AnnouncementsView All

Web Announcement 1173

Medicaid Services Manual Chapters Updated

The following Medicaid Services Manual (MSM) chapters have been updated and posted to the Division of Health Care Financing and Policy (DHCFP) website:

Web Announcement 1172

Payerpath Claim Submission Training for July 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: nvmmis.edisupport@hpe.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.

Claim Form Day Date Time*
CMS-1500 Tuesday July 12 7 to 8 a.m.
ADA Wednesday July 13 7 to 8 a.m.
CMS-1500 Tuesday July 19 7 to 8 a.m.
UB Wednesday July 20 7 to 8 a.m.
CMS-1500 Wednesday July 27 7 to 8 a.m.

*All times indicated are Pacific Time (PT).

Web Announcement 1171

Attention Provider Type 33: Claims for Equipment Rental or Purchase When Cumulative Rental Payments Reach or Exceed Purchase Price

Effective on claims processed on or after June 20, 2016, Durable Medical Equipment (DME) claims for equipment rentals that have cumulative rental payments, in a rolling two-year period, reaching or exceeding the purchase price, will deny with edit code 0424 (Rental equipment price exceeds purchase price). Unless the item is identified in the DMEPOS Fee Schedule as a rental only, once the total cumulative payments have reached the maximum Medicaid allowable purchase rate, the item is considered purchased in full and recipient-owned. DME claims for equipment purchases will be cut back with edit code 0425 (Allowed amount reduced by rental payment already made) by the cumulative rental payments for the same equipment in a rolling two-year period.

Web Announcement 1170

Attention Provider Type 22 Specialty 079: Claims for Codes D0330, D0340, D0350 and D0470

Claims for dental codes D0330 (Dental panoramic film), D0340 (Dental cephalometric film), D0350 (Oral/facial photo images) and D0470 (Diagnostic casts) submitted by provider type 22 (Dentist) specialty 079 (Orthodontia) with dates of service on or after March 1, 2015, and before June 20, 2016, may have denied inappropriately with edit code 0453 (Enrolled in HMO). Effective with claims processed on or after June 20, 2016, these claims will adjudicate appropriately.

The claims with dates of service on or after March 1, 2015, and before June 20, 2016, that denied inappropriately will be automatically reprocessed. A future web announcement will notify providers when the claims will be reprocessed.

Web Announcement 1169

Attention Provider Types 10, 20, 24, 46, 72 and 77: Prior Authorization Required for CPT Code 65756 and HCPCS Code V2785

Attention provider types (PTs) 10, 20, 24, 46, 72 and 77: Prior authorization (PA) is required for Current Procedural Terminology (CPT) code 65756 (Transplant of outer layer of corneal tissue). Effective on claims with dates of service on or after July 1, 2016, claims for CPT code 65756 submitted by PTs 10, 20, 24, 46, 72 and 77 will deny if no PA is on file.

Attention PTs 10 and 46: PA is required for Healthcare Common Procedure Coding System (HCPCS) code V2785 (Corneal tissue processing). Effective on claims with dates of service on or after July 1, 2016, claims for HCPCS code V2785 submitted by PTs 10 and 46 will deny if no PA is on file.

Web Announcement 1168

Third Quarter 2016 Provider Training Workshops

The schedule for the third quarter provider training workshops is available on the 2016 Nevada Medicaid Provider Training Registration Site. Please visit the registration site for locations, dates, times and length of sessions for the workshops.

The third quarter workshops include:

Topic Course Description
New Provider Orientation The New Provider Orientation is open to all new providers. This workshop will get you started billing Medicaid and provides information about getting started at www.medicaid.nv.gov.
Medicaid Basics This workshop is open to all Medicaid providers and will include a high-level overview of the Medicaid program, website navigation, getting started on EVS/ARS, claims overview, and the benefits of using electronic billing (EDI).
Vision This workshop is targeted to provider type 25: Optometry. The training will include the fundamentals of Nevada Medicaid, claims overview, and the benefits of using EDI. A guest speaker from the Division of Health Care Financing and Policy (DHCFP) will present the policy for this provider type.
Personal Care Services This workshop will target provider type 30: Personal Care Services. The training will include the fundamentals of Nevada Medicaid, claims overview, and the benefits of using EDI. A guest speaker from the DHCFP will present the policy for this provider type.
Behavioral Health This workshop will target Behavioral Health providers. The training will include the fundamentals of Nevada Medicaid, claims overview, and the benefits of using EDI. A guest speaker from the DHCFP will present the policy for this provider type.
Dental This virtual workshop is targeted to provider type 22 (Dental) and will include a guest speaker from the DHCFP to discuss updates to Dental policy.
Nursing Facility Tracking Form This virtual workshop will focus on the changes to the Nursing Facility Tracking Form. Information will include navigating the form, resolving validation errors and submitting attachments.
ICF/IID Tracking Form This virtual workshop will focus on the changes to the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Tracking Form. Information will include navigating the form, resolving validation errors and submitting attachments.

Web Announcement 1167

Attention Provider Type 54: Explanation of Benefits from Other Health Care Provider Not Required

Effective with claims processed on or after June 20, 2016, provider type 54 (Targeted Case Management) is no longer required to submit an Explanation of Benefits (EOB) or denial letter from the other health care (OHC) coverage provider. The Billing Guidelines for provider type 54 have been updated with this information.

Web Announcement 1166

Urgent: Payment Delay for Certain Claims

Due to the upcoming end of the Nevada state fiscal year on June 30, 2016, it is anticipated that there may be a delay in claims payment for services provided to Nevada Medicaid recipients. The pended claims will potentially affect all provider types. Any affected claims will pend with edit code 0291 (Suspended for Budget Relief). Affected claims that would normally pay on remittance advices dated June 17, 2016, and June 24, 2016, will automatically be released for adjudication on remittance advices dated July 1, 2016.

Providers are reminded that they can avoid holding for a Customer Service Call Center representative by verifying the status of claims through the Electronic Verification System (EVS) on the Provider Web Portal or the Automated Response System (ARS).

  • EVS is accessed through the Nevada Medicaid website at www.medicaid.nv.gov. Select the “EVS” tab to review the User Manual and to register or login to EVS. EVS User Manual Chapter 3 provides step-by-step instructions on searching and viewing claims that providers have submitted.
  • ARS is accessed by telephone by calling (800) 942-6511.

Web Announcement 1165

Medical Transportation Management (MTM) Will Be Nevada’s Non-Emergency Transportation Vendor Effective July 1, 2016

Effective July 1, 2016, Medical Transportation Management (MTM) will be the new non-emergency transportation (NET) broker for Nevada Medicaid recipients. NET is provided to Medicaid recipients when they require transportation to Medicaid eligible services.

MTM’s phone line will open on June 15, 2016, to begin taking reservations for July 1 and future dates. LogistiCare will continue to provide rides through June 30, 2016.

Recipients and medical staff can schedule rides Monday through Friday, 7 a.m. to 5 p.m. An after-hours call center is also available 24 hours a day, seven days a week for hospital discharges, urgent calls or for late rides.

Currently, MTM’s Education, Training, and Outreach (ETO) Team is contacting medical facilities throughout the State of Nevada to schedule in-service sessions with staff, to introduce MTM’s forms, answer questions, and to offer training on MTM’s Service Management Portal (SMP). SMP allows medical personnel to arrange transportation for recipients online in lieu of calling MTM. To contact a member of MTM’s ETO Team, please send an e-mail to #ETO-NV@mtm-inc.net.

The MTM staff looks forward to working with Nevada health care providers to provide high-quality NET services to Medicaid recipients.

MTM contact information:
    Website: www.mtm-inc.net/nevada
    To schedule a ride (reservations): 1-844-879-7341
    We Care Line (complaints): 1-866-436-0457
    Education, training and outreach for Nevada Medicaid providers: #ETO-NV@mtm-inc.net

On this website and on documents posted herein:

Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes, descriptions and data are copyrighted by the American Medical Association (AMA) and the American Dental Association (ADA), respectively, all rights reserved. AMA and ADA assume no liability for data contained or not contained on this website and on documents posted herein.

CPT is a registered trademark ® of the AMA. CDT is a registered trademark ® of the ADA. Applicable FARS/DFARS apply.

The Nevada Division of Health Care Financing and Policy adheres to all applicable privacy policies and standards, including HIPAA rules and regulations, regarding protected health information. Click here to see the State of Nevada Online Privacy Policy

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