Nevada Medicaid and Nevada Check Up News (First 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

Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Please be advised that claims must be submitted before noon Pacific Time on Fridays to be included in the following weeks’ remittance advice.

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 March 2024 Professional Claims. See Web Announcement 3335.

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

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023. See Web Announcement 3280.

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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... Medicaid does not place a limit on the number of covered days. The 180-day MCO coverage requirement applies to every nursing facility admission, regardless of the recipient receiving ...
Terms matched: 1  -  Score: 68  -  27 Sep 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3175_20230927.pdf
... information documented in the Fee for Service (FFS) or Managed Care Organization (MCO) policy billing manuals. Nevada Medicaid currently consists of three different health care ...
Terms matched: 1  -  Score: 104  -  15 Sep 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1259_20161103.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: 38  -  25 Aug 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19_20191125.pdf
... nursing facility services. If a recipient was enrolled in a Managed Care Organization (MCO) upon admission, that MCO is responsible for the first 180 days of ...
Terms matched: 1  -  Score: 38  -  24 Aug 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19.pdf
... paid claims as recouped to allow PT 63 to submit the claims to the appropriate MCO. Results of the reprocessed claims will appear on a future remittance advice. ...
Terms matched: 1  -  Score: 39  -  07 Aug 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3141_20230807.pdf
... appropri- HMO Plan ate Nevada Medicaid HMO/Managed Care Organiza- tion (MCO) for processing. Provider may find out which MCO the recipient be- ...
Terms matched: 1  -  Score: 24  -  11 Jul 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume_20_Issue_2_20230711.pdf
... the enrollees to have sufficient time to choose an MCO and return their letter to ... Nevada Check Up Managed Care Organization (MCO) 2023 Open Enrollment Managed Care Organization ...
Terms matched: 2  -  Score: 154  -  27 Jun 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3103_20230627.pdf
... , procuring a vendor that providers can choose to utilize, but also allows providers ... program-integrity/index.html Managed Care Organization (MCO) Network Providers: • ...
Terms matched: 2  -  Score: 64  -  20 Jun 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Provider_Enrollment_Information_Booklet.pdf
... 2022 32 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 195  -  23 May 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20230223.pdf
... claim to the by HMO Plan appropriate Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the recipient belongs to ...
Terms matched: 1  -  Score: 36  -  18 May 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3078_20230518.pdf
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