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]

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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 September 2024 Professional Claims. See Web Announcement 3465.

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

Top Prior Authorization Denial Reasons for the Third Quarter of 2024. See Web Announcement 3488.

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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361. Opioid_Use_Disorder_Agents_2020-09.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  -  12 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Use_Disorder_Agents_2020-09.pdf
362. Anticonvulsants_2020-09.pdf
... ; November 2017. • Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. www.uptodate.com. Updated November 9, 2019 ...
Terms matched: 1  -  Score: 10  -  12 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anticonvulsants_2020-09.pdf
363. web_announcement_Volume 17, Issue 2_20200713.pdf
... links to Nevada ’s Managed 3 Top Prior Authorization Care Organization (MCO) websites. Denial Reasons Compiled to Assist Providers with • The ...
Terms matched: 1  -  Score: 16  -  13 Jul 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2017,%20Issue%202_20200713.pdf
364. EVS_User_Manual_Chapter_2.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  -  09 Jul 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS_User_Manual_Chapter_2.pdf
365. NV_EnrollmentChecklist_PT82.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: 21  -  24 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT82.pdf
366. NV_BillingGuidelines_PT54_20190131.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  -  17 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20190131.pdf
367. NV_BillingGuidelines_PT54.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. If ... disenroll from the Managed Care Organization (MCO) based on an SMI determination. ...
Terms matched: 2  -  Score: 98  -  17 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54.pdf
368. SilverSummit_DUR_Binder_July_2020.pdf
... Members 32 Standard Reports 37 Psychotropics for Children Clinical Presentation 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 105  -  16 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_July_2020.pdf
369. Anthem_DUR_Binder_July_2020.pdf
... to NV DUR Board on July 23, 2020 Psychotropic Agents DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 92  -  16 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_July_2020.pdf
370. FFS_DUR_Binder_July_2020.pdf
... RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. ... Carl has presented based off the other MCO recommendations? Dave England: This is ...
Terms matched: 2  -  Score: 73  -  16 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_July_2020.pdf
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