Nevada Medicaid and Nevada Check Up News (Second 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, September 22, 2024, 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:
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    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
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  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

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 July 2024 Professional Claims. See Web Announcement 3398.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

Top Prior Authorization Denial Reasons for the Second Quarter of 2024. See Web Announcement 3427.

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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241. Health_Plan_of_Nevada_DUR_Binder_Jan_2021.pdf
... Drug Use Review Board Meeting JANUARY 28, 2021 2021 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 60  -  04 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_Jan_2021.pdf
242. Health_Plan_of_Nevada_DUR_Binder_Oct_2020.pdf
... Drug Use Review Board Meeting OCTOBER 22, 2020 2020 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 60  -  25 Sep 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_Oct_2020.pdf
243. web_announcement_1423_20170808.pdf
... of Health Care Financing and Policy (DHCFP) as a Managed Care Organization (MCO) for Nevada Medicaid and Nevada Check Up recipients will end. Medicaid and ...
Terms matched: 1  -  Score: 59  -  08 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1423_20170808.pdf
244. Binder_DUR_2018_1018.pdf
... unfortunately similar to what the other ones are. After seeing their recommendations from the MCO as saying that they would just like to keep this criteria. Chapter 1200 ...
Terms matched: 1  -  Score: 59  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2018_1018.pdf
245. Atypical (Second-Generation) Antipsychotics_07232012.pdf
... first 1 to 2 weeks of therapy; therefore, this must be considered when choosing an agent for 10 the acute treatment of schizophrenia. Lurasidone is indicated for ...
Terms matched: 1  -  Score: 59  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Atypical%20(Second-Generation)%20Antipsychotics_07232012.pdf
246. Atypical (Second-Generation) Antipsychotics.pdf
... first 1 to 2 weeks of therapy; therefore, this must be considered when choosing an agent for 10 the acute treatment of schizophrenia. Lurasidone is indicated for ...
Terms matched: 1  -  Score: 59  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Atypical%20(Second-Generation)%20Antipsychotics.pdf
247. web_announcement_2658_20211217.pdf
... 2658 Attention All Providers: Recipient/Enrollee Webpage Created with Managed Care Organization (MCO) Expansion Information Effective immediately, a new webpage has been created on the ...
Terms matched: 1  -  Score: 58  -  17 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2658_20211217.pdf
248. NV_BillingGuidelines_PT75_20111111.pdf
... DHCFP that have swing bed licensure and certification. Requesting Authorization To request authorization: MCO vs. FFS ï ‚ Complete and fax form FA-3 or FA-8 as When ...
Terms matched: 1  -  Score: 58  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_20111111.pdf
249. 2_Medicaid_Program_Highlights_DHCFP_2014.pdf
... • Advanced Practice Registered Nurses • Physician Forums with FFS and MCO • Prior Authorization Alignment between FFS and MCO • Health ...
Terms matched: 1  -  Score: 57  -  30 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2_Medicaid_Program_Highlights_DHCFP_2014.pdf
250. Anthem_DUR_Binder_Jan_2021.pdf
... Presentation Presented to NV DUR Board on January 28, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 57  -  06 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Jan_2021.pdf
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