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]

Notifications

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 January 2025 Professional Claims. See Web Announcement 3559.

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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... Presentation Presented to NV DUR Board on October 22, 2020 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 63  -  25 Sep 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Oct_2020.pdf
... - 24 Standard DUR Reports - 26 Topical Antipruritics Clinical Presentation DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 60  -  25 Sep 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_Oct_2020.pdf
... Drug Use Review Board Meeting OCTOBER 22, 2020 2020 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 60  -  25 Sep 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_Oct_2020.pdf
... ) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod ... CMS. The Fee-for- Service and MCO Surveys will be presented at the next ...
Terms matched: 2  -  Score: 31  -  25 Sep 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_Oct_2020.pdf
... , program oversight of managed care partners when applicable, and statewide (FFS and MCO) initiatives. The Drug Use Review Board (DUR) is a requirement ...
Terms matched: 1  -  Score: 12  -  25 Sep 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Survey_FFY2019.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 23  -  03 Sep 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Multiple_Sclerosis_Agents_2020-09.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 66  -  17 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_Sept_2020.pdf
... – ª Self directed providers disabilities) $175 billion â – ª Providers that choose to accept funds must attest to the terms and conditions in payments to be ...
Terms matched: 1  -  Score: 41  -  14 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Relief_Fund_Step-by-Step_Provider_Guide.pdf
... be submitted to the Nevada Medicaid fiscal agent, not the Managed Care Organization (MCO) . Please see the ADA Claim Form Instructions and the Orthodontic Medical Necessity ...
Terms matched: 1  -  Score: 20  -  14 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20190410.pdf
... patients at increased risk of stroke and have undergone PCI, it is reasonable to choose Plavix over Effient. Double therapy with a P2Y12 inhibitor (Plavix or Brilinta ...
Terms matched: 1  -  Score: 22  -  12 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet_Aggregation_Inhibitors_2020-09.pdf
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