Nevada Medicaid and Nevada Check Up News (First Quarter 2025 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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Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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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31. NV_BillingGuidelines_PT29.pdf
... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 36  -  18 Mar 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29.pdf
32. NV_Billing_General.pdf
... 2025 30 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: 199  -  14 Mar 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
33. NV_Provider_Enrollment_Information_Booklet.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: 52  -  14 Mar 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Provider_Enrollment_Information_Booklet.pdf
34. NV_Billing_General_20250205.pdf
... 2024 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  -  21 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250205.pdf
35. web_announcement_3559_20250220.pdf
... claim to the appropriate by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3559_20250220.pdf
36. Encounter-Professional_837P_MCO_Companion_Guide_-_Mod.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: 286  -  06 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Professional_837P_MCO_Companion_Guide_-_Mod.pdf
37. Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.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: 269  -  06 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
38. Encounter-Dental_837D_MCO_Companion_Guide_-_Mod.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: 241  -  06 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Dental_837D_MCO_Companion_Guide_-_Mod.pdf
39. NV_Billing_General_20241018.pdf
... 2024 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  -  05 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20241018.pdf
40. web_announcement_3547_20250204.pdf
... to be applied to the document and includes the necessary information. If a provider chooses to use electronic signatures, that provider is responsible for the technical support of ...
Terms matched: 1  -  Score: 20  -  04 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3547_20250204.pdf
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