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.

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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... Web Portal www.medicaid.nv.gov Nevada Medicaid New Provider Orientation 18 Nevada Medicaid Managed Care Organizations (MCO) Nevada Medicaid Managed Care Organizations The DHCFP oversees the administration of all Nevada ...
Terms matched: 1  -  Score: 21  -  11 Jan 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/New_Provider_Orientation_011118.pdf
... Benefits Administrator (DBA) to serve recipients enrolled in a Managed Care Organization (MCO) in Washoe and Clark counties. The following information will assist Medicaid dental ...
Terms matched: 1  -  Score: 23  -  11 Jan 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2018-0111.pdf
... Benefits Administrator (DBA) to serve recipients enrolled in a Managed Care Organization (MCO) in Washoe and Clark counties. The following information will assist Medicaid dental ...
Terms matched: 1  -  Score: 23  -  11 Jan 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4550_20180111.pdf
... , will no longer deny in error with edit code 0453 (Enrolled in an MCO) effective January 1, 2018. Claims with dates of service on or ...
Terms matched: 1  -  Score: 20  -  25 Jan 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1507_20180125.pdf
... Managed Care Organizations (MCOs) . Recipients who have Amerigroup Community Care for their MCO will receive new identification cards. Recipient benefits will remain the same. Providers ...
Terms matched: 1  -  Score: 20  -  30 Jan 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1510_20180130.pdf
... , 2018, that denied in error with edit code 0453 (Enrolled in an MCO) have been automatically reprocessed. Results of the reprocessed claims appear on remittance ...
Terms matched: 1  -  Score: 20  -  22 Feb 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1531_20180222.pdf
... œSubmitâ€Nevada Medicaid Therapy Provider Training 35 Delegate Assignment, continued †' Choose the Functions you want the delegate to be able to perform †' ...
Terms matched: 1  -  Score: 26  -  18 Apr 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Therapy_Provider_Training_041818.pdf
... Delegate Assignment, continued †' Choose the Functions you want the delegate to ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for-Service (FFS): ...
Terms matched: 2  -  Score: 79  -  24 Apr 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PCS_Provider_Training_042418.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
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim) . The ...
Terms matched: 1  -  Score: 129  -  25 Jun 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NCPDP_Encounter_Companion_Guide_Mod_n061818.pdf
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