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]

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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:
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    • 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.

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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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301. NV_BillingGuidelines_PT10_20170724.pdf
... versus Fee For Service 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: 36  -  25 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20170724.pdf
302. 2012_Behavorial_Health_Presentation_v1_0.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing • Only qualified providers prescribe services within scope of their practice under ...
Terms matched: 1  -  Score: 13  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2012_Behavorial_Health_Presentation_v1_0.pdf
303. 201306_Verifying_Eligibility.pdf
... remain on the line and make a note of the verification number. NOTE: MCO Eligibility and eligibility verification number are provided at the end of the call. ...
Terms matched: 1  -  Score: 116  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/201306_Verifying_Eligibility.pdf
304. 2013_Care_Management.pdf
... 6386 VLBW 179 189 184 169 Rate 2.34% 2.48% 2.73% 2.65% MCO Live Births 6671 7955 8963 8363 VLBW 70 86 110 100 Rate 1.05% ...
Terms matched: 1  -  Score: 26  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2013_Care_Management.pdf
305. 3_Division_of_Welfare_DWSS_2014.pdf
... Expanded Call Center 2014 Annual Medicaid Conference 2015 Open Enrollment • Clients who choose to use the pre-screener and are determined potentially eligible for a Qualified Health Plan ...
Terms matched: 1  -  Score: 36  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/3_Division_of_Welfare_DWSS_2014.pdf
306. 5-HT1 Receptor Agonists_2015-1002.pdf
... (P value not reported) . When permitted to years of age with attacks choose between eletriptan and sumatriptan SC for subsequent treatment, 78% of vs migraine ...
Terms matched: 1  -  Score: 26  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/5-HT1%20Receptor%20Agonists_2015-1002.pdf
307. 6_Health_Care_Guidance_Program_2014.pdf
... ) • Those receiving Targeted Case Management (TCM) • MCO enrollees • Nevada Check-Up enrollees (CHIP) • Emergency ...
Terms matched: 1  -  Score: 23  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/6_Health_Care_Guidance_Program_2014.pdf
308. 837_Encounter-Dental_837D_MCO_Mod_n061818.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: 228  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Dental_837D_MCO_Mod_n061818.pdf
309. 837_Encounter-Institutional_837I_MCO_Mod_n061818.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: 210  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Institutional_837I_MCO_Mod_n061818.pdf
310. 837_Encounter-Professional_837P_MCO_Mod_n061818.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: 222  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Professional_837P_MCO_Mod_n061818.pdf
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