Nevada Medicaid and Nevada Check Up News (First Quarter 2025 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: Known Issue with Resubmitting Returned to Provider (RTP) Applications
This issue has been resolved, and the impacted applications have been placed in the appropriate status for review.

Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types 24, 72, 74, and 77:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from April 14, 2025 – April 21, 2025. Please refer to Web Announcement 3595 for details.

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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2025 Professional Claims. See Web Announcement 3593.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2024. See Web Announcement 3458.

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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191. Anthem_DUR_Binder_October_2021.pdf
... Presentation Presented to NV DUR Board on October 14, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 88  -  28 Sep 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_October_2021.pdf
192. web_announcement_301_20091230.pdf
... Ill (SMI) may elect to disenroll from the Medicaid Managed Care Organization (MCO) program. However, the recipient must be redetermined as SED or SMI ...
Terms matched: 1  -  Score: 87  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_301_20091230.pdf
193. web_announcement_1463_20171026.pdf
... in Condition checkbox selected, along with a copy of the approved authorization from the MCO. This MCO documentation must include the service type (PCS), approved ...
Terms matched: 1  -  Score: 84  -  26 Oct 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1463_20171026.pdf
194. 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
195. NV_BillingGuidelines_PT22_20051021.pdf
... eligibility. Recipients in these eligibility programs are transitioned to a Managed Care Organization (MCO) at the beginning of their second month of eligibility. After transitioning to ...
Terms matched: 1  -  Score: 83  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20051021.pdf
196. Anthem_DUR_Binder_April_2020.pdf
... Presentation Presented to NV DUR Board on April 30, 2020 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 83  -  06 Apr 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2020.pdf
197. NV_OPE_User_Manual_Ch2.pdf
... select the type of ownership from the drop-down list. Business Information: 1. Choose the option that most closely describes the entity you are enrolling. Select the ...
Terms matched: 1  -  Score: 83  -  15 Oct 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_OPE_User_Manual_Ch2.pdf
198. COVID_Flyers.pdf
... public for in-person services** If you are in a Managed Care Plan (MCO) â€" Please call your plan at: Anthem Blue Cross and ...
Terms matched: 1  -  Score: 83  -  03 Feb 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/COVID_Flyers.pdf
199. Nevada Provider Training - Dental.pdf
... . Select a Site Key image 8. Enter a unique Passphrase 8 9. Choose 3 Challenge Questions from the 9 dropdown list and create a unique answer for ...
Terms matched: 1  -  Score: 83  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Provider%20Training%20-%20Dental.pdf
200. EVS Early Registration.pdf
... assign multiple delegates to perform clinical administration. Providers, please note: If you choose to have an office administrator register on your behalf, the administrator must use ...
Terms matched: 1  -  Score: 82  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS%20Early%20Registration.pdf
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