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

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 September 2024 Professional Claims. See Web Announcement 3465.

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

Top Prior Authorization Denial Reasons for the Third Quarter of 2024. See Web Announcement 3488.

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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... 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
... 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
... 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
... 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
... How does EVS notify me that a recipient is in a Managed Care Organization (MCO)? If a recipient is enrolled in an MCO, the detail may ...
Terms matched: 1  -  Score: 150  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Training_FrequentlyAskedQuestions.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X223A2 Institutional health care claims and MCO encounter claims (837I) 6-1 7. Payer specific business rules and limitations ...
Terms matched: 1  -  Score: 145  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837I_hipaa-0-12.pdf
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the RTC stay. Recipients ...
Terms matched: 1  -  Score: 141  -  21 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63.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. ï ‚ ...
Terms matched: 1  -  Score: 138  -  29 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20170629.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X222A1 Professional health care claims and MCO encounter claims (837P) .... 6-1 7. Payer specific business rules ...
Terms matched: 1  -  Score: 137  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P_hipaa-01-12.pdf
... Provider Enrollment Requirement The 21st Century Cures Act requires all Medicaid Managed Care Organization (MCO) network providers to enroll with the Medicaid Program prior to enrolling with any ...
Terms matched: 1  -  Score: 131  -  06 Dec 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1768_20181206.pdf
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