Nevada Medicaid and Nevada Check Up News (Third 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


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 September 2024 Professional Claims. See Web Announcement 3465.

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.

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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.

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... Nevada Medicaid and Nevada Check Up â€" Managed Care Organization(MCO) Change Form If you would like to request a change to your MCO, ...
Terms matched: 1  -  Score: 286  -  12 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NMO_5006E-S_MCO_Change_Form.pdf
... Drug Use Review Board Meeting JANUARY 27, 2022 2022 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 113  -  11 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_January_2022.pdf
... DUR Reports â€" 41 CGRP Antagonists Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 115  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_January_2022.pdf
... Presentation Presented to NV DUR Board on January 27, 2022 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 115  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_January_2022.pdf
... presented many challenges to State's in terms of drug coverage, meetings, and ___ MCO(s ) (Insert program monitoring. Nevada 3 the number Medicaid of ...
Terms matched: 1  -  Score: 88  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Survey_FFY2020.pdf
... biologic agents, it is reasonable to choose gradual step therapy with 5-ASA. â ... if they would like to change their MCO enrollment. Dr. Capurro informed the ...
Terms matched: 2  -  Score: 21  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_January_2022.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 39  -  04 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20211228.pdf
... Up News Volume 18, Issue 4 New Managed Care Organization Fourth Quarter 2021 (MCO) Contract and Caseload Inside Redistribution Effective January 1, 2022 This Issue: ...
Terms matched: 1  -  Score: 296  -  03 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume_2018_20Issue_204_20211230.pdf
... Up News Volume 18, Issue 4 New Managed Care Organization Fourth Quarter 2021 (MCO) Contract and Caseload Inside Redistribution Effective January 1, 2022 This Issue: ...
Terms matched: 1  -  Score: 296  -  30 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2018%20Issue%204_20211230.pdf
... recipients regardless if they are under FFS Medicaid or a Medicaid Managed Care Organization (MCO) . Use Direct Data Entry (DDE) to submit claims to Nevada ...
Terms matched: 1  -  Score: 21  -  23 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20191022.pdf
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