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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... Guide A Residential Treatment Center (RTC) is a A Managed Care Organization (MCO) mental health facility having 17 beds or provides all medical care (e.g ...
Terms matched: 1  -  Score: 49  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20100625.pdf
... ) A Residential Treatment Center (RTC) is a A Managed Care Organization (MCO) mental health facility having 17 beds or provides all medical care (e.g ...
Terms matched: 1  -  Score: 49  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20090801.pdf
... Jeffery: Duane brought up a good point. Because we have to incorporate the MCO data with this too. We didn't give them an opportunity to opine on ...
Terms matched: 1  -  Score: 48  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2018_0124.pdf
... Service (FFS) 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: 47  -  25 May 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_100115.pdf
... billers: Please refer to the Transaction 837D â€" Dental Health Benefits and MCO or Care Claim and Encounter Companion Guide for billing instructions. The Fee-for-Service Enrollment ...
Terms matched: 1  -  Score: 47  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2014-0502.pdf
... Service (FFS) 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: 47  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_070115.pdf
... : • Answer the Challenge Question to verify identity. • Choose whether log in is on a personal computer or public computer. †...
Terms matched: 1  -  Score: 46  -  27 Oct 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Therapy_Provider_Training_093020.pdf
... , Thrombolytic antithrombotic therapy is not recommended. For patients who th Therapy 9 Edition choose antithrombotic therapy, aspirin (75 to 325 mg daily) is 9 ( ...
Terms matched: 1  -  Score: 46  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet%20Inhibitors_07262012.pdf
... ), Thrombolytic antithrombotic therapy is not recommended. For patients who Therapy 9th Edition choose antithrombotic therapy, aspirin (75 to 325 mg daily) is (2012 ...
Terms matched: 1  -  Score: 46  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet%20Inhibitors.pdf
... Daily files will be generated if DHCFP has updates for a recipient enrolled in an MCO. If no updates are performed, then no enrollment file will be generated ...
Terms matched: 1  -  Score: 46  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834)_-_Mod.pdf
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