Nevada Medicaid and Nevada Check Up News (Fourth 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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Multi-Factor Authentication Frequently Asked Questions

Unwinding COVID-19 Information

Known System Issues-Click HERE

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 December 2024 Professional Claims. See Web Announcement 3538.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

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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69 results found containing all search terms. 709 results found containing some search terms.

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... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 35  -  01 Jul 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20190405.pdf
... “Formsâ€page, locate the “Hospice Formsâ€section and choose appropriate forms. †' Make sure that all instructions are followed. ...
Terms matched: 1  -  Score: 88  -  16 Aug 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Hospice_Provider_Training_042519.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  -  22 Aug 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Use_Disorder_Agents_2019-09.pdf
... , 2019. ï ‚ Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. 2019[b ] . www.uptodate.com/ . Accessed ...
Terms matched: 1  -  Score: 10  -  22 Aug 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Atypical_Antipsychotics_2019-09.pdf
... to pay FQHCs providing services under a contract with a Medicaid Managed Care Organization (MCO; also known as a Managed Care Entity [MCE]) supplemental payments ...
Terms matched: 1  -  Score: 23  -  30 Aug 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20190201.pdf
... to pay FQHCs providing services under a contract with a Medicaid Managed Care Organization (MCO; also known as a Managed Care Entity [MCE]) supplemental payments ...
Terms matched: 1  -  Score: 23  -  30 Aug 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
... , 2019. ï ‚ Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. 2019[b ] . www.uptodate.com/ . Accessed ...
Terms matched: 1  -  Score: 21  -  04 Sep 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_September_2019.pdf
... Presented to NV DUR Board on October 17, 2019 1 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 126  -  19 Sep 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Oct_2019.pdf
... Standard DUR Reports 54 Natroba & Lice Treatments Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 120  -  19 Sep 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_Oct_2019.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  -  15 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Spec307.pdf
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