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]

Notifications


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 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.

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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... emergency dental care only until the recipient is transitioned to a Managed Care Organization (MCO) at the beginning of their second full month of eligibility. After transitioning ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20120712.pdf
... emergency dental care only until the recipient is transitioned to a Managed Care Organization (MCO) at the beginning of their second full month of eligibility. After transitioning ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20120201.pdf
... is transitioned to a Managed Care Effective with dates of service on or Organization (MCO) at the beginning of after July 1, 2009, for Nevada Check ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20090917.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
... emergency dental care only until the recipient is transitioned to a Managed Care Organization (MCO) at the beginning of their second full month of eligibility. After transitioning ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20111205.pdf
... 1, 2022. Medicaid recipient membership is currently with three Managed Care Organization (MCO) plans, and DHCFP will distribute the membership across the four plans on ...
Terms matched: 1  -  Score: 77  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2649_20211209.pdf
... address for the Provider Administrator (must match step 12 above) . 14) Choose a Site Key (use left or right arrows to scroll for additional Site ...
Terms matched: 1  -  Score: 77  -  24 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Web_Portal_QRG_20120110.pdf
... Reports â€" 22 Movement Disorder Agents Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 76  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_April_2022.pdf
... DUR Reports  23 Anticonvulsants, Misc. Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 76  -  04 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_Jan_2021.pdf
... risk of stroke: no therapy is suggested over antithrombotic therapy. For patients who choose antithrombotic therapy, aspirin is suggested over oral anticoagulation or combination therapy with aspirin ...
Terms matched: 1  -  Score: 75  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder%20for%20Jan%2022%20DUR%20Meeting%202015-0114.pdf
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