Nevada Medicaid and Nevada Check Up News (Third 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

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 August 2024 Professional Claims. See Web Announcement 3448.

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

Top Prior Authorization Denial Reasons for the Second Quarter of 2024. See Web Announcement 3427.

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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... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 16  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Partial_Agonists_2016-1216.pdf
... enrolled in a Managed Care exclusions, coordination of benefits and other terms Organization (MCO), request prior authorization and conditions set forth by the benefit program. ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_070110.pdf
... verify that the break-out session conference, which will address recipient eligibility, prior you choose has your provider type indicated next to it. authorization, clinical claim editor ...
Terms matched: 1  -  Score: 27  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v7i3.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 110  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20160309.pdf
... emergency dental care only until the recipient is transitioned to a Managed Care Organization (MCO) at the beginning of their second full month of eligibility. After transitioning ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20111205.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_100115.pdf
... and Behavioral Health Sessions First Health Services and the Division of Health Care Fi nancing MCO Update: DHCFP Contracts and Policy offer free, comprehensive training throughout the year ...
Terms matched: 1  -  Score: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v5i4.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_022715.pdf
... Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. ï ‚ The provider will need to submit a new ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1191_20160722.pdf
... Guide A Residential Treatment Center (RTC) is a A Managed Care Organization (MCO) mental health facility having 17 beds or provides all medical care (e.g ...
Terms matched: 1  -  Score: 49  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20100625.pdf
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