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

Enhance your search:
  • Note that you can use "*" and "?" as wildcards.

  • Enclosing more than one word in double quotes ("search engine") will search for the exact phrase.
Example Zoom search template page

Search this site

Enter one or more keywords to search for using the Zoom Search Engine.
Note that '*' and '?' wildcards are supported.



Match:

Search results for: choose mco

68 results found containing all search terms. 704 results found containing some search terms.

78 pages of results.
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 36  -  25 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20150929.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. ï ‚ ...
Terms matched: 1  -  Score: 138  -  29 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20170629.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. ï ‚ ...
Terms matched: 1  -  Score: 100  -  29 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20160608.pdf
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 36  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46_20150929.pdf
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the first month of admission ...
Terms matched: 1  -  Score: 108  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20141010.pdf
... urban Washoe counties will no longer be managed by the current Managed Care Organizations (MCO) . As of July 1, 2017, dental services and claims will ...
Terms matched: 1  -  Score: 41  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1404_20170630.pdf
... , and SilverSummit Healthplan. In preparation for the contract start date for the four MCO contracts, the Division of Health Care Financing and Policy (DHCFP) will ...
Terms matched: 1  -  Score: 73  -  01 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1405_20170630.pdf
... be denied first at the acute level of care. ï ‚ Should the provider choose to not appeal they may request these dates of service at a lower level ...
Terms matched: 1  -  Score: 20  -  10 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Quick_Tip_Guide_Inpatient_Psychiatric_and_RTC_2014-1030.pdf
... authorized to access. â"€ Choose the Functions you want the delegate to ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for- Service (FFS ...
Terms matched: 2  -  Score: 56  -  19 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PWP_PCS_Training_2017-07.pdf
... have the ability to create prior authorizations in the Provider Web Portal. If providers choose to use the Provider Web Portal, they will eliminate the need to mail ...
Terms matched: 1  -  Score: 20  -  21 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Portal_Upgrade_FAQ.pdf
Result Pages: << Previous 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Next >>

Search powered by Zoom Search Engine



Search took 0.054 seconds