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.

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12:00AM - 12:30AM

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371. ICF-IID_Tracking_Form_Validation_Guide_2016-0615.pdf
... within the recipient’s Medicaid eligibility. The member is enrolled in an MCO on the ICF/IID Tracking Form is submitted with a date(s ...
Terms matched: 1  -  Score: 52  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICF-IID_Tracking_Form_Validation_Guide_2016-0615.pdf
372. ICD-10_Testing_Instructions.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  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_Testing_Instructions.pdf
373. Hospice_Authorization_-_Claim_Training_021518.pdf
... “Formsâ€page, locate the “Hospice Formsâ€section and choose appropriate forms. †' Make sure that you follow the instructions on ...
Terms matched: 1  -  Score: 13  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Hospice_Authorization_-_Claim_Training_021518.pdf
374. Health_Care_Premium_Payment_(820)_n062818 draft.pdf
... Data (Subscriber Information 2100 C Loop) An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 24  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Premium_Payment_(820)_n062818%20draft.pdf
375. Health_Care_Premium_Payment_(820)_-_Mod.pdf
... Data (Subscriber Information 2100 C Loop) An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 24  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Premium_Payment_(820)_-_Mod.pdf
376. Foundations-New Provider Program Basics 2015-0921.pdf
... HP Enterprise Services (HPES) • Nevada Medicaid Managed Care Organizations (MCO) • Questions? 2 Foundations: New Provider Program Basics Department ...
Terms matched: 1  -  Score: 23  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Foundations-New%20Provider%20Program%20Basics%202015-0921.pdf
377. Final_Introduction_to_Nevada_Medicaid_and_Check_Up_2012-0801.pdf
... €¢ Recipients have 30 days to choose an MCO before one is assigned to ... Program requires the mandatory enrollment in an MCO of some recipients found eligible for Medicaid ...
Terms matched: 2  -  Score: 200  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Final_Introduction_to_Nevada_Medicaid_and_Check_Up_2012-0801.pdf
378. FA-57.pdf
... provider, etc.) for billing purposes. In addition, the facility may choose to obtain their own certification for their billing purposes. FA-57 Page 1 of ...
Terms matched: 1  -  Score: 20  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-57.pdf
379. FA-50.pdf
... . The physician (surgeon) must sign in this space. Section III: Choose A, B, C, or D if patient is already sterile or ...
Terms matched: 1  -  Score: 20  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-50.pdf
380. FA-17-I.pdf
... number of days per week. d) Indicate the ICD-10 code. e) Choose one of the two HCPCS codes (S5012 or S5100) for the services ...
Terms matched: 1  -  Score: 36  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-17-I.pdf
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