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:
    • Customer Service Center (877) 638-3472
    • 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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311. 837_Encounter_NET_837P_Companion_Guide_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: 63  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter_NET_837P_Companion_Guide_Mod_n061818.pdf
312. ABA_Provider_Training_021318.pdf
... continued • While on the “Formsâ€page, locate and choose appropriate forms • Make sure that you follow the instructions on each ...
Terms matched: 1  -  Score: 28  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_Provider_Training_021318.pdf
313. ADA Payerpath Training 2016-1220.pdf
... , then scroll down to View Claims. 19 Claims List Filter Select Dental 2012 Choose from Untransmitted (claims not yet sent) or Transmitted (claims that have ...
Terms matched: 1  -  Score: 21  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ADA%20Payerpath%20Training%202016-1220.pdf
314. Adjustments_Spec_Batches_Appeals_2012-0628_Final.pdf
... due to system issue • Orthodontic claims â€" recipients enrolled in MCO 15 HP Confidential â€" Special Batch and Appeals How to special batch ...
Terms matched: 1  -  Score: 20  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Adjustments_Spec_Batches_Appeals_2012-0628_Final.pdf
315. Alzheimer's Agents 2014 11.pdf
... decision whether to continue treatment with cholinesterase inhibitors is highly individualized. Reasons that patients choose to stop taking these medications include side effects, adverse events, lack of ...
Terms matched: 1  -  Score: 11  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Alzheimer's%20Agents%202014%2011.pdf
316. Alzheimer's_Agents_2013-0812.pdf
... treatment over placebo (all P<0.05) . (requires assistance vs in choosing proper Secondary: There was no significant difference between treatment groups on the NPI ...
Terms matched: 1  -  Score: 12  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Alzheimer's_Agents_2013-0812.pdf
317. Alzheimer's Agents.Nevada_2015-1002.pdf
... decision whether to continue treatment with cholinesterase inhibitors is highly individualized. Reasons that patients choose to stop taking these medications include side effects, adverse events, lack of ...
Terms matched: 1  -  Score: 11  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Alzheimer's%20Agents.Nevada_2015-1002.pdf
318. Angiotensin II Receptor Blockers 2014 11.pdf
... level of urine albumin excretion. • In adult kidney transplant recipients, choose a blood pressure -lowering agent after taking into account the time after transplantation, ...
Terms matched: 1  -  Score: 10  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Angiotensin%20II%20Receptor%20Blockers%202014%2011.pdf
319. Anticoagulants_Injectable_2018-09.pdf
... . ï ‚ Bundhun PK, Shaik M, Yuan J, et al. Choosing between enoxaparin and fondaparinux for the management of patients with acute coronary syndrome: ...
Terms matched: 1  -  Score: 12  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anticoagulants_Injectable_2018-09.pdf
320. Anticonvulsants_2017-09.pdf
... West-Ward Pharmaceuticals; December 2016. x Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. www.uptodate.com. Updated February 16, 2017 ...
Terms matched: 1  -  Score: 10  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anticonvulsants_2017-09.pdf
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