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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... recipients regardless if they are under FFS Medicaid or a Medicaid Managed Care Organization (MCO) . Use Direct Data Entry (DDE) to submit claims to Nevada ...
Terms matched: 1  -  Score: 21  -  23 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20191022.pdf
... 2658 Attention All Providers: Recipient/Enrollee Webpage Created with Managed Care Organization (MCO) Expansion Information Effective immediately, a new webpage has been created on the ...
Terms matched: 1  -  Score: 58  -  17 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2658_20211217.pdf
... a managed care health plan, you choose a doctor to be your primary care ... Recipient General and Managed Care Organization (MCO) FAQ’s Updated 10 ...
Terms matched: 2  -  Score: 275  -  15 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/MCO_FAQs_Recipients_101521_Fully_Remediated.pdf
... Nevada Medicaid and Nevada Check Up â€" Managed Care Organization (MCO) Change Form If you would like to request a change to your MCO, ...
Terms matched: 1  -  Score: 286  -  15 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NMO_5006ES_Nevada_Medicaid_and_Nevada_Check_Up_MCO_Change_Form_1021_Remediated_Fillable_102721.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 39  -  14 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20211214.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 39  -  14 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20211206.pdf
... the webpage. Prior authorization Emergency transportation services for Fee-for-service and Managed Care Organization (MCO) recipients do not require prior authorization. Payment is contingent upon eligibility, ...
Terms matched: 1  -  Score: 108  -  07 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_932_online_20200430.pdf
... the webpage. Prior authorization Emergency transportation services for Fee-for-service and Managed Care Organization (MCO) recipients do not require prior authorization. Payment is contingent upon eligibility, ...
Terms matched: 1  -  Score: 109  -  07 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_932.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 39  -  06 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20211119.pdf
... Care Organizations (MCOs) . This change takes effect with the new Nevada Medicaid MCO contracts that begin January 1, 2022. The Division of Health Care Financing ...
Terms matched: 1  -  Score: 36  -  01 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2640_20211201.pdf
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