Nevada Medicaid and Nevada Check Up News (Second 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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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. Known_Issues.pdf
... 1 /2019 6/25/2019 Managed Care, Managed Care Organization (MCO), all details on NDC (National outpatient or outpatient cross-over claims are ...
Terms matched: 1  -  Score: 40  -  09 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_BillingGuidelines_PT29_online_20250318.pdf
... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 36  -  09 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20250318.pdf
3. NV_BillingGuidelines_PT29.pdf
... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 36  -  09 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29.pdf
4. Error_Code_to_EOB_to_ANSI.pdf
... Identification Segment (loop 2110 Service Payment Information REF), if present. 3365 MCO PAID DATE IS INVALID 1644 MCO Paid Date is Invalid. 16 Claim/ ...
Terms matched: 1  -  Score: 22  -  08 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
5. Provider_Enrollment_Information_Booklet.pdf
... the provider(s ) to link to the group. Managed Care Organization (MCO) Network Providers: • All MCO Network providers must be enrolled ...
Terms matched: 1  -  Score: 37  -  08 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. web_announcement_Volume 22 Issue 2_20250707.pdf
... to the appropriate ered by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the PWP by re ...
Terms matched: 1  -  Score: 12  -  07 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2022%20Issue%202_20250707.pdf
7. FA-16B.pdf
... ASSESSING THE RECIPIENT’S NEEDS. ASSESSMENT NEEDS MEDICATION/IV DELIVERY NEEDS Choose one: This is based on the severity of illness and the stability of ...
Terms matched: 1  -  Score: 174  -  20 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-16B.pdf
8. Benefit_Enrollment_and_Maintenance_(834).pdf
... are performed, then no enrollment file will be generated and made available to the MCO. Monthly Files • Monthly files include members which have a maintenance ...
Terms matched: 1  -  Score: 84  -  17 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
9. NV_Flex_User_Guide_Individual.pdf
... Filesâ€button. 2. Click the “Select Filesâ€button and choose a PDF to attach. • Attachments must be in PDF format ...
Terms matched: 1  -  Score: 12  -  12 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
10. NV_Flex_User_Guide_Group.pdf
... not link individuals are required to select “Biller and Performerâ€13. Choose the option that most closely describes the entity you are enrolling in. Group ...
Terms matched: 1  -  Score: 14  -  06 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
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