Nevada Medicaid and Nevada Check Up News (First Quarter 2025 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]

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NOTIFICATION: Known Issue with Resubmitting Returned to Provider (RTP) Applications
This issue has been resolved, and the impacted applications have been placed in the appropriate status for review.

Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types 24, 72, 74, and 77:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from April 14, 2025 – April 21, 2025. Please refer to Web Announcement 3595 for details.

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2025 Professional Claims. See Web Announcement 3593.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2024. See Web Announcement 3458.

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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21. NV_Billing_General_20201117.pdf
... 2020 35 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 456  -  23 May 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20201117.pdf
22. Introduction to Becoming a Nevada Medicaid Provider 2013-0122.pdf
... €¢ Recipients have 30 days to choose an MCO before one is assigned to ... Program requires the mandatory enrollment in an MCO of some recipients found eligible for Medicaid ...
Terms matched: 2  -  Score: 451  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Introduction%20to%20Becoming%20a%20Nevada%20Medicaid%20Provider%202013-0122.pdf
23. E-Binder_March_2015.pdf
... have 5 minutes per entity, so choose who you are going to have speak ... TPL format to more align with the MCO structure that can reduce some of the ...
Terms matched: 2  -  Score: 449  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_March_2015.pdf
24. Binder_DUR_2019-0425.pdf
... reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting ... ? There are some differences with the MCO. Jennifer Wheeler: They changed to ...
Terms matched: 2  -  Score: 421  -  20 Mar 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2019-0425.pdf
25. NV_BillingGuidelines_PT54_20100219.pdf
... with SED or Prior Authorization Requirements SMI chooses to disenroll from the MCO. ( ... weekly or monthly. Care Organization (MCO) enrollment is mandatory, may disenroll ...
Terms matched: 2  -  Score: 401  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20100219.pdf
26. NV_Billing_General_online_2005-12-29_to_2007-08-09.pdf
... recipient or his/her guardian may choose to send an appeal to the DHCFP ... Dates of eligibility • Which MCO (or “HMOâ€) ...
Terms matched: 2  -  Score: 393  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2005-12-29_to_2007-08-09.pdf
27. EVS User Manual Chapter 1_o092617-n122818 Modernization.pdf
... Providers, please note: If you choose to have an office administrator register on ... Registering as a Managed Care Organization (MCO) A user registers only once when ...
Terms matched: 2  -  Score: 390  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS%20User%20Manual%20Chapter%201_o092617-n122818%20Modernization.pdf
28. PCS_Provider_Training_(2019_Version)_2019-0603.pdf
... to verify identity. • Choose whether log in is on a personal ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for-Service (FFS) â ...
Terms matched: 2  -  Score: 383  -  03 Jun 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PCS_Provider_Training_(2019_Version)_2019-0603.pdf
29. NV_BillingGuidelines_PT54 o100111-online120511-n110215.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 375  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54%20o100111-online120511-n110215.pdf
30. NV_BillingGuidelines_PT54_20160617.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 375  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20160617.pdf
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