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]

Notifications

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.

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.

Scheduled Site Maintenance

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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... , 2017. Upgrades to the Nevada Medicaid Provider Web Portal that benefit all (MCO) Changes Effective providers will include: July 1, 2017 ï ‚ increased ...
Terms matched: 1  -  Score: 211  -  04 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2017-0714.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 210  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Institutional_837I_MCO_Mod_n061818.pdf
... sections that follow provide details on Fee-For-Service (FFS) and Managed Care Organization (MCO) Claims. Fee-for-service claims Q: Why does Nevada Medicaid require a National ...
Terms matched: 1  -  Score: 189  -  10 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NDC_Frequently_Asked_Questions.pdf
... Announcement 2655 Attention All Providers: Recipients May Request to Change Managed Care Organization (MCO) Plans In December, Medicaid recipients who are members of Managed Care Organizations ...
Terms matched: 1  -  Score: 186  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2655_20211215.pdf
... eligibility For recipients age 21 and older, Nevada programs are not transitioned to an MCO. Medicaid covers only necessary dentures, emergency extractions and palliative care. It ...
Terms matched: 1  -  Score: 183  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20080519.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  -  07 Oct 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-16B.pdf
... Medicaid Provider Web Portal (PWP) from version 4.0 to version 5.0. (MCO) Changes Effective All user information will be automatically migrated over to the new ...
Terms matched: 1  -  Score: 174  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2017-0424.pdf
... 27, 2017 Announcement 1331 Attention All Nevada Medicaid Providers: Managed Care Organization (MCO) Changes Effective 2017 Effective July 1, 2017, the Division of Health ...
Terms matched: 1  -  Score: 168  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1331_20170327.pdf
... 26, 2017 Announcement 1380 Attention All Nevada Medicaid Providers: Managed Care Organization (MCO) Changes Effective 2017 Effective July 1, 2017, the Division of Health ...
Terms matched: 1  -  Score: 168  -  26 May 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1380_20170526.pdf
... of managed care. They will either be enrolled in a Managed Care Organization (MCO) because their household or case members are enrolled in it, because they ...
Terms matched: 1  -  Score: 155  -  29 May 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_735_20140519.pdf
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