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.

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

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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301. Trading_Partner_User_Guide.pdf
... Options This section describes the connectivity options from which a Trading Partner will need to choose for the submission of transactions. Nevada Medicaid supports multiple methods for exchanging electronic ...
Terms matched: 1  -  Score: 68  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Trading_Partner_User_Guide.pdf
302. NV_BillingGuidelines_PT54_20170328.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: 110  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20170328.pdf
303. NV_BillingGuidelines_PT56_20160223.pdf
... . Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. For ...
Terms matched: 1  -  Score: 35  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56_20160223.pdf
304. Nevada Provider Training - Institutional.pdf
... . Select a Site Key image 8. Enter a unique Passphrase 8 9. Choose 3 Challenge Questions from the 9 dropdown list and create a unique answer for ...
Terms matched: 1  -  Score: 94  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Provider%20Training%20-%20Institutional.pdf
305. Nevada Provider Training - Dental.pdf
... . Select a Site Key image 8. Enter a unique Passphrase 8 9. Choose 3 Challenge Questions from the 9 dropdown list and create a unique answer for ...
Terms matched: 1  -  Score: 83  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Provider%20Training%20-%20Dental.pdf
306. Nevada Provider Training - Professional.pdf
... . Select a Site Key image 8. Enter a unique Passphrase 8 9. Choose 3 Challenge Questions from the 9 dropdown list and create a unique answer for ...
Terms matched: 1  -  Score: 103  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Provider%20Training%20-%20Professional.pdf
307. NV_Billing_General_20180907.pdf
... ï ‚ Prior Authorization requirements ï ‚ New TPL contractor contact information ï ‚ New MCO contact information 08/08/2008 Chapter 8 updated to reflect the mandatory ...
Terms matched: 1  -  Score: 284  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20180907.pdf
308. NV_EnrollmentChecklist_PT14_specialty_814.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing; 7. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  04 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_specialty_814.pdf
309. NV_EnrollmentChecklist_PT82_specialty_882.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing. g. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  04 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT82_specialty_882.pdf
310. Opioid_Use_Disorder_Agents_2019-03.pdf
... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 16  -  11 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Use_Disorder_Agents_2019-03.pdf
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