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

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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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301. Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
... the guidelines regarding the specific CSFs within the class. The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
302. Benefit_Enrollment_and_Maintanance_(834)_n062818.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: 43  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintanance_(834)_n062818.pdf
303. Clinical_Material_2016-0411.pdf
... guidelines regarding the specific CSFs within the class. o The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Clinical_Material_2016-0411.pdf
304. web_announcement_2676_20220106.pdf
... Cancel Services or Request Out of Pocket Payment from Recipients Who Were Assigned a New MCO as of January 1, 2022 Effective January 1, 2022, Nevada Medicaid ...
Terms matched: 1  -  Score: 42  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2676_20220106.pdf
305. web_announcement_104_092806.pdf
... Date: 09/28/06 Web Announcement 104 Managed Care Organization (MCO) Changes The Division of Health Care Financing and Policy (DHCFP) is ...
Terms matched: 1  -  Score: 42  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_104_092806.pdf
306. web_announcement_2187_20200506.pdf
... PT) 32 ambulance providers, were carved out of the Managed Care Organization (MCO) contracts and are now billed as Fee-for-Service Medicaid. Some GEMT claims for ...
Terms matched: 1  -  Score: 42  -  06 May 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2187_20200506.pdf
307. NV_BillingGuidelines_PT43_20180829.pdf
... EPSDT) program. Managed Care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 41  -  29 Aug 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20180829.pdf
308. NV_BillingGuidelines_PT43_20170322.pdf
... the EPSDT program. Managed care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 41  -  29 Aug 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20170322.pdf
309. Provider_Enrollment_Information_Booklet.pdf
... form and proof of account information in the attachments panel. Managed Care Organization (MCO) Network Providers: • All MCO Network providers must be enrolled ...
Terms matched: 1  -  Score: 41  -  17 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
310. NV_BillingGuidelines_PT43_20111205.pdf
... the EPSDT program. Managed care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20111205.pdf
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