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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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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191. 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
192. 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
193. 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
194. 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
195. 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
196. 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
197. 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
198. 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
199. companionguide820.pdf
... specified.) This Companion Guide provides specific requirements for providing Managed Care Organization (MCO) capitation payment information using the EDI 820 transaction. HP Enterprise Services creates ...
Terms matched: 1  -  Score: 81  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide820.pdf
200. NV_BillingGuidelines_PT22_20100120.pdf
... transitioned to a Managed Care Effective with dates of service on or after Organization (MCO) at the beginning of July 1, 2009, for Nevada Check Up ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20100120.pdf
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