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

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.

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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... 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_20090325.pdf
... beginning Jan. 1, 2011, but may start the process immediately if they choose to do so. The re-enrollment requirement does not apply to providers who enrolled ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_363_20101101.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
... menu) . Managed Care Hospitals may provide services to Medicaid Managed Care Organization (MCO) recipients but must request reimbursement from the MCO. There are no carve-outs ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20100701.pdf
... Home and Community Based Assisted Living Waiver 60 School Based 62 Managed Care Organization (MCO) 63 Residential Treatment Center (RTC) 64 Hospice 65 Hospice, Long ...
Terms matched: 1  -  Score: 12  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Provider_Enrollment_Instructions.pdf
... through evaluation, a recipient may elect to disenroll from the Managed Care Organization (MCO) . The MCO is required to notify DHCFP of such election. If ...
Terms matched: 1  -  Score: 104  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20050601.pdf
... with SED or Prior Authorization Requirements SMI chooses to disenroll from the MCO. ( ... weekly or monthly. Care Organization (MCO) enrollment is mandatory, may disenroll ...
Terms matched: 2  -  Score: 134  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20100219.pdf
... online to get the challenge questions, it asked me a question I did not choose. Remember, the Provider Web Portal will not be active until December 5 ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SR-100_20111123.pdf
... Date: 09/28/06 Web Announcement 104 Managed Care Organization (MCO) Changes The Division of Health Care Financing and Policy (DHCFP) is ...
Terms matched: 1  -  Score: 42  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_104_092806.pdf
... and recipient is transitioned to a Managed Care routine maintenance to promote dental Organization (MCO) at the beginning of health. their second full month of eligibility. ...
Terms matched: 1  -  Score: 100  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20090801.pdf
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