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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381. Exondys_51_2017-0314.pdf
... . Particular care needs to be taken with such patients in deciding which glucocorticoid to choose, when to initiate treatment, and how best to monitor the child for ...
Terms matched: 1  -  Score: 12  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Exondys_51_2017-0314.pdf
382. EVS User Manual Chapter 1_o092617-n122818 Modernization.pdf
... Providers, please note: If you choose to have an office administrator register on ... Registering as a Managed Care Organization (MCO) A user registers only once when ...
Terms matched: 2  -  Score: 115  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS%20User%20Manual%20Chapter%201_o092617-n122818%20Modernization.pdf
383. EVS Early Registration.pdf
... assign multiple delegates to perform clinical administration. Providers, please note: If you choose to have an office administrator register on your behalf, the administrator must use ...
Terms matched: 1  -  Score: 82  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS%20Early%20Registration.pdf
384. Erythropoiesis-Stimulating Agents.pdf
... who had a baseline hemoglobin level of 10 to 13 g/dL, not choose to rHuEPO significantly reduced the proportion of patients who received a red- The ...
Terms matched: 1  -  Score: 11  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Erythropoiesis-Stimulating%20Agents.pdf
385. Enrollment Termination FAQs 09-20-16.pdf
... 7. How do I Re-enroll once I've been terminated? You may re-enroll and choose a back date to reduce any lapse of Nevada Medicaid enrollment. To do ...
Terms matched: 1  -  Score: 52  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Enrollment%20Termination%20FAQs%2009-20-16.pdf
386. Encounter NCPDP Companion Guide - Mod n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim) . The ...
Terms matched: 1  -  Score: 129  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter%20NCPDP%20Companion%20Guide%20-%20Mod%20n061818.pdf
387. Emflaza_2017-0918.pdf
... . Particular care needs to be taken with such patients in deciding which glucocorticoid to choose, when to initiate treatment, and how best to monitor the child for ...
Terms matched: 1  -  Score: 12  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Emflaza_2017-0918.pdf
388. E-Binder_PT_September_2017.pdf
... West-Ward Pharmaceuticals; December 2016. x Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. www.uptodate.com. Updated February 16, 2017 ...
Terms matched: 1  -  Score: 10  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_September_2017.pdf
389. E-Binder_PT_September_2018.pdf
... . ï ‚ Bundhun PK, Shaik M, Yuan J, et al. Choosing between enoxaparin and fondaparinux for the management of patients with acute coronary syndrome: ...
Terms matched: 1  -  Score: 11  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_September_2018.pdf
390. E-Binder_PT_September_2016.pdf
... Griffith: This criteria is for fee for service only, this will not affect MCO coverage. Robert Horne: I understand that, if it comes off the ...
Terms matched: 1  -  Score: 12  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_September_2016.pdf
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