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

Monday
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391. E-Binder_PT_November_2018.pdf
... , placental transfer data in this patient subpopulation, women sometimes feel the need to choose between treatment and starting a family. The FDA recognized the need for robust ...
Terms matched: 1  -  Score: 107  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_November_2018.pdf
392. E-Binder_PT_March_2018.pdf
... DAA experience patients and retreatment. I’m not here to advocate for choosing one agent over another. All the DAA single tablet regimens have established high ...
Terms matched: 1  -  Score: 24  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_March_2018.pdf
393. E-Binder_PT_March_2017.pdf
... Carl Jeffery: You can certainly make Orencia preferred. We did our best to choose what we thought would work well. Nikki Beck: I would make a ...
Terms matched: 1  -  Score: 12  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_March_2017.pdf
394. E-Binder_March_2015.pdf
... have 5 minutes per entity, so choose who you are going to have speak ... TPL format to more align with the MCO structure that can reduce some of the ...
Terms matched: 2  -  Score: 98  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_March_2015.pdf
395. E-Binder_PT_June_2018.pdf
... DAA experience patients and retreatment. I’m not here to advocate for choosing one agent over another. All the DAA single tablet regimens have established high ...
Terms matched: 1  -  Score: 24  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_June_2018.pdf
396. DME_PT33_Provider_Training_042618.pdf
... Nevada Medicaid Durable Medical Equipment Provider Training 51 Delegate Assignment, continued †' Choose the Functions you want the delegate to be able to perform †' ...
Terms matched: 1  -  Score: 25  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_PT33_Provider_Training_042618.pdf
397. Dental_and_Orthodontia_PWP_Training_120117.pdf
... now select role-based functions that a delegate is authorized to access. †' Choose the Functions you want the delegate to be able to Provider Web Portal 5.0 ...
Terms matched: 1  -  Score: 39  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Dental_and_Orthodontia_PWP_Training_120117.pdf
398. companionguide837P_hipaa.pdf
... Protocol (SFTP) client software and it is up to the trading partner to choose which client software they will use. Nevada Medicaid does not provide or recommend ...
Terms matched: 1  -  Score: 14  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P_hipaa.pdf
399. companionguide837P.pdf
... Nevada Medicaid and Nevada Check Up Professional Health Care Claims and Managed Care Organization (MCO) Encounters Nevada Medicaid Management Information System (NV MMIS) State of Nevada ...
Terms matched: 1  -  Score: 223  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P.pdf
400. companionguide837P_hipaa-01-12.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X222A1 Professional health care claims and MCO encounter claims (837P) .... 6-1 7. Payer specific business rules ...
Terms matched: 1  -  Score: 137  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P_hipaa-01-12.pdf
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