Nevada Medicaid and Nevada Check Up News (Third 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]

Notifications

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 August 2024 Professional Claims. See Web Announcement 3448.

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.

Scheduled Site Maintenance

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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... . For Managed Care A0428 Ambulance service, basic life 1 unit per Organization (MCO) enrollees, check with the support, non-emergency transport claim MCO for special ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_20100630.pdf
... 2 Diabetes Awareness Page 3 Billing Tips/Reminders Page 2 PERM Update Page 3 MCO Work Group Page 4 Nevada Medicaid News Updates on Major Issues NPI/API ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v4i4.pdf
... claims matching the ICD-9 baseline, trading partners can continue submitting ICD-10 claims of their choosing. ï ‚ Trading partners that cannot create a claim based off an 835 ...
Terms matched: 1  -  Score: 38  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_Testing_Instructions.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. â ...
Terms matched: 1  -  Score: 38  -  19 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT21.pdf
... nursing facility services. If a recipient was enrolled in a Managed Care Organization (MCO) upon admission, that MCO is responsible for the first 45 days of ...
Terms matched: 1  -  Score: 38  -  25 Aug 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19_20191125.pdf
... in a Managed Care and/or respiratory therapists’ drawing of Organization (MCO), it is the laboratory’s arterial blood. responsibility to ...
Terms matched: 1  -  Score: 38  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20101202.pdf
... by the Division of Health Care Financing and Policy (DHCFP) Benefits, and MCO or 10 business days prior to the date of the requested training. If ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2015-0710.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request PA from and submit claims to the MCO. For recipients ...
Terms matched: 1  -  Score: 38  -  07 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20200203.pdf
... these billing instructions for outstanding affected claims: ï ‚ If providers have been denied MCO payment for these claims and they have submitted the claim to Magellan Medicaid Administration ...
Terms matched: 1  -  Score: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_459_20120321.pdf
... tips and instructions, timely filing, appeals and many more topics. Providers may choose to attend a morning or an afternoon conference in either Reno or Las Vegas ...
Terms matched: 1  -  Score: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_352_20100917.pdf
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