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.

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Monday
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... provider affiliate testing the For recipients enrolled in a Managed Care specimen. Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 37  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20100628.pdf
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 37  -  14 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10.pdf
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 37  -  25 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46.pdf
... doctors and medical providers About 75,000 Medicaid members in rural Consider joining an MCO network. MCOs will Nevada will be enrolled in an MCO. About be ...
Terms matched: 1  -  Score: 37  -  18 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3310_20240318.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: 37  -  26 Nov 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19_20190131.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: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19_20111205.pdf
... . Fee for Service 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: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_20111205.pdf
... EVV system. Essentials to Know: State EVV Sandata Users: If a provider chooses to use the state EVV system through Sandata, they can continue to have ...
Terms matched: 1  -  Score: 37  -  11 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3186_20231011.pdf
... Care Organizations (MCOs) . This change takes effect with the new Nevada Medicaid MCO contracts that begin January 1, 2022. The Division of Health Care Financing ...
Terms matched: 1  -  Score: 36  -  01 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2640_20211201.pdf
... bill the additional charges at the rates listed on the applicable Managed Care Organization (MCO) or Medicaid Fee For Service (FFS) fee schedules. For example ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_208_090308.pdf
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