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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... EPSDT) program. Managed Care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 41  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20220202.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  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3023_20230302.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: 129  -  06 Feb 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NCPDP_Encounter_Companion_Guide.pdf
... services. Nevada Check Up recipients are not disenrolled from a Managed Care Organization (MCO) when they receive hospice services. Although Nevada Check Up recipients receiving hospice ...
Terms matched: 1  -  Score: 64  -  26 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65_online_20210421.pdf
... services. Nevada Check Up recipients are not disenrolled from a Managed Care Organization (MCO) when they receive hospice services. Although Nevada Check Up recipients receiving hospice ...
Terms matched: 1  -  Score: 64  -  26 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65.pdf
... Options This section describes the connectivity options from which a Trading Partner will need to choose for the submission of transactions. Nevada Medicaid supports multiple methods for exchanging electronic ...
Terms matched: 1  -  Score: 68  -  20 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EDI_Trading_Partner_User_Guide.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  -  20 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2985_20230120.pdf
... five (5 ) times to enroll and credential with each Managed Care Organization (MCO) and/or Dental Benefit Administrator (DBA) . Nevada Medicaid wants ...
Terms matched: 1  -  Score: 20  -  13 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2979_20230113.pdf
... Crisis Stabilization Center services there will be a carve-out for MCOs, meaning recipients with MCO coverage will be reimbursed through Fee-For-Service (FFS) . NRS 695C.194 reads the ...
Terms matched: 1  -  Score: 20  -  06 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2975_20230106.pdf
... accordance with 42 CFR Â 438.602(b ), this requirement will apply to MCO network providers who order, prescribe or refer services/supplies for individuals enrolled ...
Terms matched: 1  -  Score: 37  -  05 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/OPR_FAQs.pdf
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