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]

Notifications

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:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR
  • 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.

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 their answer to 4 the Challenge Question to verify identity. 5 4. Choose whether log in is on a personal computer or public computer. 5. ...
Terms matched: 1  -  Score: 56  -  12 Jun 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_13_Psychiatric_Hospital_Inpatient_Training_2019.pdf
... the Direct Managed Care Enrollment process to enroll recipients into their Managed Care Organization (MCO) immediately upon approval of their Medicaid eligibility. This change will give Medicaid ...
Terms matched: 1  -  Score: 56  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1353_20170417.pdf
... for no prior authorization due to a change in eligibility from Managed Care Organization (MCO) to Fee-for-Service (FFS) after a newborn’s date of ...
Terms matched: 1  -  Score: 56  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_988_20150929.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 56  -  16 Sep 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_September_2021.pdf
... 13 and 14, 2023, those who reside in a Managed Care Organization (MCO) coverage area were placed back into their last Managed Care Plan that they ...
Terms matched: 1  -  Score: 55  -  09 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3184_20231009.pdf
... the DUR is the third from the top is ingredient duplication. We continue to choose a new topic for RetroDUR every quarter and send out letters each month. ...
Terms matched: 1  -  Score: 55  -  17 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_Jan_2020.pdf
... stroke: no therapy is suggested over antithrombotic therapy. For Therapy and patients who choose antithrombotic therapy, aspirin is suggested over Prevention of oral anticoagulation or combination therapy ...
Terms matched: 1  -  Score: 53  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet%20Inhibitors_2015-1002.pdf
... stroke: no therapy is suggested over antithrombotic therapy. For Therapy and patients who choose antithrombotic therapy, aspirin is suggested over Prevention of oral anticoagulation or combination therapy ...
Terms matched: 1  -  Score: 53  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet%20inhibitors%202014%2011.pdf
... within the recipient’s Medicaid eligibility. The member is enrolled in an MCO on the NF form is submitted with a recipient that has date(s ...
Terms matched: 1  -  Score: 53  -  20 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nursing_Facility_Tracking_Form_Validation_Guide_%202016-0615.pdf
... within the recipient’s Medicaid eligibility. The member is enrolled in an MCO on the NF form is submitted with a recipient that has date(s ...
Terms matched: 1  -  Score: 53  -  20 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nursing%20Facility%20Tracking%20Form%20Validation%20Guide%202016-0615.pdf
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