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 May 2024 Professional Claims. See Web Announcement 3382.

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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... these billing instructions for outstanding affected claims: ï ‚ If providers have been denied MCO payment for these claims and they have submitted the claim to Magellan Medicaid Administration ...
Terms matched: 1  -  Score: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_459_20120321.pdf
... may transition from Fee for Service (FFS) to a Managed Care Organization (MCO) when determining a treatment plan. If you have any questions regarding the ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_569_20130225.pdf
... ) 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_20090801.pdf
... not require prior authorization. For Managed support, non-emergency transport claim Care Organization (MCO) enrollees, check A0429 Ambulance service, basic life 1 unit per with ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_online_20091123.pdf
... in a Managed • Revenue code 0123: NF Pediatric Care Organization (MCO) upon Specialty Care I or NF Pediatric admission, that MCO is responsible ...
Terms matched: 1  -  Score: 35  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19_20090801.pdf
... to you. The conference will host a series of breakout sessions that providers can choose when they register for the conference. The following breakout sessions are planned for ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1219_20160901.pdf
... sessions. To register, click on “Register Here,⠀then choose Reno or Las Vegas from the drop-down list. Scroll down to †...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_514_20120831.pdf
... be included in each session. When providers register, they will be asked to choose either the morning or afternoon session at the location of their choice. The ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_807_20140924.pdf
... the Direct Managed Care Enrollment process to enroll recipients into their Managed Care Organization (MCO) immediately upon approval of their Medicaid eligibility. This change will give Medicaid ...
Terms matched: 1  -  Score: 56  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1353_20170417.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
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