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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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:
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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.

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401. SilverSummit_DUR_Binder_July_2020.pdf
... Members 32 Standard Reports 37 Psychotropics for Children Clinical Presentation 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 105  -  16 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_July_2020.pdf
402. NV_BillingGuidelines_PT54_20190131.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 110  -  17 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20190131.pdf
403. NV_BillingGuidelines_PT54.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. If ... disenroll from the Managed Care Organization (MCO) based on an SMI determination. ...
Terms matched: 2  -  Score: 98  -  17 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54.pdf
404. NV_EnrollmentChecklist_PT82.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing. g. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 21  -  24 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT82.pdf
405. EVS_User_Manual_Chapter_2.pdf
... the Nevada Medicaid and Nevada Check Up program as well as Managed Care Organizations (MCO) and Third Party Liability (TPL) . The eligibility request is sent ...
Terms matched: 1  -  Score: 130  -  09 Jul 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS_User_Manual_Chapter_2.pdf
406. web_announcement_Volume 17, Issue 2_20200713.pdf
... links to Nevada ’s Managed 3 Top Prior Authorization Care Organization (MCO) websites. Denial Reasons Compiled to Assist Providers with • The ...
Terms matched: 1  -  Score: 16  -  13 Jul 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2017,%20Issue%202_20200713.pdf
407. Anticonvulsants_2020-09.pdf
... ; November 2017. • Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. www.uptodate.com. Updated November 9, 2019 ...
Terms matched: 1  -  Score: 10  -  12 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anticonvulsants_2020-09.pdf
408. Platelet_Aggregation_Inhibitors_2020-09.pdf
... patients at increased risk of stroke and have undergone PCI, it is reasonable to choose Plavix over Effient. Double therapy with a P2Y12 inhibitor (Plavix or Brilinta ...
Terms matched: 1  -  Score: 22  -  12 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet_Aggregation_Inhibitors_2020-09.pdf
409. Opioid_Use_Disorder_Agents_2020-09.pdf
... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 16  -  12 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Use_Disorder_Agents_2020-09.pdf
410. NV_BillingGuidelines_PT22_20190410.pdf
... be submitted to the Nevada Medicaid fiscal agent, not the Managed Care Organization (MCO) . Please see the ADA Claim Form Instructions and the Orthodontic Medical Necessity ...
Terms matched: 1  -  Score: 20  -  14 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20190410.pdf
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