Nevada Medicaid and Nevada Check Up News (First Quarter 2025 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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For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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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1. Binder_DUR_2019_0124.pdf
... really be controlled by the clinician who chooses to administer the product in his or ... : It would help to know which MCO you’re referring to. ...
Terms matched: 2  -  Score: 633  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2019_0124.pdf
2. MCO_FAQs_Recipients_101521_Fully_Remediated.pdf
... a managed care health plan, you choose a doctor to be your primary care ... Recipient General and Managed Care Organization (MCO) FAQ’s Updated 10 ...
Terms matched: 2  -  Score: 549  -  15 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/MCO_FAQs_Recipients_101521_Fully_Remediated.pdf
3. web_announcement_3385_20240702.pdf
... the enrollees to have sufficient time to choose an MCO and return their request by ... Nevada Check Up Managed Care Organization (MCO) 2024 Open Enrollment Managed Care Organization ...
Terms matched: 2  -  Score: 527  -  02 Jul 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3385_20240702.pdf
4. Binder_DUR_2019-0725.pdf
... Growth Hormone Managed Care Organization name: Choose an item. Please place a check ... we have similar limits to every other MCO and fee for service as well as ...
Terms matched: 2  -  Score: 490  -  18 Jun 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2019-0725.pdf
5. web_announcement_3456_20241009.pdf
... starting October 1, 2024, to choose a new health plan. Recipients go ... Nevada Check Up Managed Care Organization (MCO) 2024 Open Enrollment Managed Care Organization ...
Terms matched: 2  -  Score: 486  -  09 Oct 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3456_20241009.pdf
6. Binder_DUR_2018_0726.pdf
... what the choices between which agent to choose. There is no preference for the ... is when Medicaid recipient transfers from one MCO to another? Jim Marx: Right ...
Terms matched: 2  -  Score: 478  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2018_0726.pdf
7. Final_Introduction_to_Nevada_Medicaid_and_Check_Up_2012-0801.pdf
... €¢ Recipients have 30 days to choose an MCO before one is assigned to ... Program requires the mandatory enrollment in an MCO of some recipients found eligible for Medicaid ...
Terms matched: 2  -  Score: 470  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Final_Introduction_to_Nevada_Medicaid_and_Check_Up_2012-0801.pdf
8. NV_Billing_General.pdf
... 2025 30 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 468  -  14 Mar 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. web_announcement_2834_20220706.pdf
... the enrollees to have sufficient time to choose an MCO and return their letter to ... Nevada Check Up Managed Care Organization (MCO) 2022 Open Enrollment Managed Care Organization ...
Terms matched: 2  -  Score: 462  -  06 Jul 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2834_20220706.pdf
10. web_announcement_3103_20230627.pdf
... the enrollees to have sufficient time to choose an MCO and return their letter to ... Nevada Check Up Managed Care Organization (MCO) 2023 Open Enrollment Managed Care Organization ...
Terms matched: 2  -  Score: 462  -  27 Jun 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3103_20230627.pdf
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