Nevada Medicaid and Nevada Check Up News (Fourth 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]

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NOTIFICATION:The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, January 26, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

Multi-Factor Authentication Frequently Asked Questions

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 December 2024 Professional Claims. See Web Announcement 3538.

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.

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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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121. 201306_Verifying_Eligibility.pdf
... remain on the line and make a note of the verification number. NOTE: MCO Eligibility and eligibility verification number are provided at the end of the call. ...
Terms matched: 1  -  Score: 116  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/201306_Verifying_Eligibility.pdf
122. 2013_Care_Management.pdf
... 6386 VLBW 179 189 184 169 Rate 2.34% 2.48% 2.73% 2.65% MCO Live Births 6671 7955 8963 8363 VLBW 70 86 110 100 Rate 1.05% ...
Terms matched: 1  -  Score: 26  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2013_Care_Management.pdf
123. 2012_Behavorial_Health_Presentation_v1_0.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing • Only qualified providers prescribe services within scope of their practice under ...
Terms matched: 1  -  Score: 13  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2012_Behavorial_Health_Presentation_v1_0.pdf
124. web_announcement_Volume 21 Issue 3_20240926.pdf
... HMO Plan Nevada Medicaid Health Maintenance Organization (HMO)/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by review ...
Terms matched: 1  -  Score: 20  -  26 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2021%20Issue%203_20240926.pdf
125. web_announcement_3448_20240923.pdf
... claim to the appropriate Nevada by HMO Plan Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  23 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3448_20240923.pdf
126. web_announcement_3432_20240905.pdf
... Behavioral Health Centers, CCBHCs) needs to be enrolled with Managed Care Organizations (MCO) . See Web Announcement 2649 for more information about MCO enrollment. Claims ...
Terms matched: 1  -  Score: 114  -  05 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3432_20240905.pdf
127. NV_BillingGuidelines_PT87_Spec250.pdf
... first complete year of operation as a provider of ICSS, providers of ICSS who choose to have a cost-based bundled daily rate will be required to submit a cost ...
Terms matched: 1  -  Score: 23  -  03 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250.pdf
128. web_announcement_3424_20240826.pdf
... HMO Plan Nevada Medicaid Health Maintenance Organization (HMO)/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  26 Aug 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3424_20240826.pdf
129. web_announcement_3423_20240822.pdf
... to be applied to the document and includes the necessary information. If a provider chooses to use electronic signatures, that provider is responsible for the technical support of ...
Terms matched: 1  -  Score: 20  -  22 Aug 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3423_20240822.pdf
130. 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  -  19 Aug 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
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