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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411. companionguide820_hipaa.pdf
... EDI 835 transaction) . 7.3. Frequency An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 24  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide820_hipaa.pdf
412. companionguide820.pdf
... specified.) This Companion Guide provides specific requirements for providing Managed Care Organization (MCO) capitation payment information using the EDI 820 transaction. HP Enterprise Services creates ...
Terms matched: 1  -  Score: 81  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide820.pdf
413. companionguide270-271_hipaa.pdf
... Protocol (SFTP) client software and it is up to the trading partner to choose which client software they will use. HPES does not provide or recommend any ...
Terms matched: 1  -  Score: 13  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide270-271_hipaa.pdf
414. Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
... the guidelines regarding the specific CSFs within the class. The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
415. CMS-1500_Instructions_posted_2011-12-05_through_2013-05-14.pdf
... ER visit payment 1048 Primary carrier has paid full charges 1072 Newborn/Mother in MCO, bill MCO 1049 Recipient not eligible 1073 Credit balance process 1050 Services not ...
Terms matched: 1  -  Score: 25  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/CMS-1500_Instructions_posted_2011-12-05_through_2013-05-14.pdf
416. CMS Payerpath Training 2016-1205.pdf
... | Email: nvmmis.edisupport@dxc.com 19 Claims List Filter Select Form: Type Professional Choose from Untransmitted (claims not yet sent) or Transmitted (claims that have ...
Terms matched: 1  -  Score: 21  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/CMS%20Payerpath%20Training%202016-1205.pdf
417. Clinical_Material_2016-0411.pdf
... guidelines regarding the specific CSFs within the class. o The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Clinical_Material_2016-0411.pdf
418. Claims_and_PA_Conference_Presentation.pdf
... €œSubmitâ€Nevada Medicaid Provider Training 58 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/Claims_and_PA_Conference_Presentation.pdf
419. Botulinum_Toxins_2013-1218.pdf
... of Lower bladder retraining or habit retraining) . Urinary Tract • When choosing a behavioral management program, take into account Dysfunction that prompted voiding and habit ...
Terms matched: 1  -  Score: 10  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Botulinum_Toxins_2013-1218.pdf
420. Binder_DUR_2019_0124.pdf
... really be controlled by the clinician who chooses to administer the product in his or ... : It would help to know which MCO you’re referring to. ...
Terms matched: 2  -  Score: 277  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2019_0124.pdf
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