Nevada Medicaid and Nevada Check Up News (First Quarter 2024 Provider Newsletter) [Read]

Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Announcement 850]

If you are a Medicaid provider whose revalidation application has not been processed by your termination due date, you 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. See Web Announcement 1265

Enrollment Termination Frequently Asked Questions (FAQs) [Review]

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Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Please be advised that claims must be submitted before noon Pacific Time on Fridays to be included in the following weeks’ remittance advice.

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, June 2, 2024, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

Paper claims are no longer accepted by Nevada Medicaid. Please refer to Web Announcement 1733 and Web Announcement 1829 for additional information.

Top 10 Claim Denial Reasons and Resolutions/Workarounds for April 2024 Professional Claims. See Web Announcement 3361.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023. See Web Announcement 3280.

Attention Providers Using the Authorization Criteria Function: Results that return prior authorization (PA) requirements are accurate. For results that return “There are no records found based on the search criteria,” there may be a PA requirement if limits have been exceeded. To verify PA requirements, please refer to the Medicaid Services Manual (MSM) Chapter for your service type at dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

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451. Third Generation Cephalosporins.pdf
... and Precaution Generic Elderly/ Hepatic Pregnancy Excreted in Name Renal Dysfunction Children Dysfunction Category Breast Milk Cefdinir No dosage A dose of 300 mg No dosage B Not adjustment ...
Terms matched: 1  -  Score: 22  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Third%20Generation%20Cephalosporins.pdf
452. NV_PDL_20210101.pdf
... NEW TAZORAC® ATRALIN® ZIANA® AVITA® EPIDUO® RETIN-A MICRO®(Pump and Tube) NEW TAZAROTENE NEW TRETINOIN TRETIN-X® VELTIN® Electrolytic and Renal ...
Terms matched: 1  -  Score: 22  -  31 Dec 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_PDL_20210101.pdf
453. NV_PDL_20210401.pdf
... PEROXIDE TAZORAC® ATRALIN® ZIANA® AVITA® EPIDUO® RETIN-A MICRO®(Pump and Tube) TAZAROTENE TRETINOIN TRETIN-X® VELTIN® Electrolytic and Renal Agents Phosphate ...
Terms matched: 1  -  Score: 22  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_PDL_20210401.pdf
454. NV_PDL_20210528.pdf
... PEROXIDE TAZORAC® ATRALIN® ZIANA® AVITA® EPIDUO® RETIN-A MICRO®(Pump and Tube) TAZAROTENE TRETINOIN TRETIN-X® VELTIN® Electrolytic and Renal Agents Phosphate ...
Terms matched: 1  -  Score: 22  -  28 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_PDL_20210528.pdf
455. Oral Anticoagulants_092212.pdf
... and Precaution Generic Elderly/ Hepatic Pregnancy Excreted in Name Renal Dysfunction Children Dysfunction Category Breast Milk Dabigatran No dosage Renal dosage Not reported C Unknown etexilate adjustment adjustment is ...
Terms matched: 1  -  Score: 22  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Oral%20Anticoagulants_092212.pdf
456. NV_BillingGuidelines_PT27_online_021512.pdf
... age 40+ and for women ages 35-39 who are considered at high risk for breast cancer. For all women ages 35-39, a baseline mammogram is allowed once ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT27_online_021512.pdf
457. Ophthalmic Nonsteroidal 2014 11.pdf
... and Precaution Generic Renal Hepatic Pregnancy Excreted in Name Elderly/Children Dysfunction Dysfunction Category Breast Milk Bromfenac No evidence of overall Not reported Not reported C* Unknown; ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Ophthalmic%20Nonsteroidal%202014%2011.pdf
458. Ophthalmic Nonsteroidal Anti-Inflammatory Drugs_2015-1002.pdf
... and Precaution Generic Renal Hepatic Pregnancy Excreted in Name Elderly/Children Dysfunction Dysfunction Category Breast Milk Bromfenac No evidence of overall Not reported Not reported C* Unknown; ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Ophthalmic%20Nonsteroidal%20Anti-Inflammatory%20Drugs_2015-1002.pdf
459. Ophthalmic Prostaglandin Analogues.pdf
... and Precaution Generic Name Elderly/ Renal Hepatic Pregnancy Excreted in Children Dysfunction Dysfunction Category Breast Milk Single-Entity Products Bimatoprost No differences Not reported No adverse C Unknown in safety ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Ophthalmic%20Prostaglandin%20Analogues.pdf
460. Inhaled Anticholinergics.pdf
... and Precaution Generic Name Elderly/ Renal Hepatic Pregnancy Excreted in Children Dysfunction Dysfunction Category Breast Milk Single Entity Agents Aclidinium No dosage No dosage Not studied in C Probable ...
Terms matched: 1  -  Score: 21  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Anticholinergics.pdf
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