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.

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

Monday
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351. EVS User Manual Chapter 2 o072417-n122818 Modernization.pdf
... the Nevada Medicaid and Nevada Check Up program as well as Managed Care Organizations (MCO) and Third Party Liability (TPL) . The eligibility request is sent ...
Terms matched: 1  -  Score: 130  -  06 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS%20User%20Manual%20Chapter%202%20o072417-n122818%20Modernization.pdf
352. 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
353. 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
354. 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
355. 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
356. 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
357. 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
358. 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
359. 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
360. FA-24C.pdf
... form) . I have the ability and desire to self-direct my care, to choose the ISO provider, to select personal care assistants (PCA), to ...
Terms matched: 1  -  Score: 26  -  31 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-24C.pdf
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