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]

Notifications

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.

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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... the enrollees to have sufficient time to choose an MCO and return their letter to ... Nevada Check Up Managed Care Organization (MCO) 2023 Open Enrollment Managed Care Organization ...
Terms matched: 2  -  Score: 154  -  27 Jun 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3103_20230627.pdf
... 2022 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  -  23 May 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20230223.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  -  18 May 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3078_20230518.pdf
... (e.g., therapy, wound care, diabetic training, Care Organization (MCO), request PA minor surgeries.) from and submit claims to the ...
Terms matched: 1  -  Score: 38  -  20 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_2011-0606.pdf
... (e.g., therapy, wound care, diabetic training, Care Organization (MCO), request PA minor surgeries.) from and submit claims to the ...
Terms matched: 1  -  Score: 38  -  19 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_2008-1119.pdf
... (e.g., therapy, wound care, diabetic training, Care Organization (MCO), request PA minor surgeries.) from and submit claims to the ...
Terms matched: 1  -  Score: 38  -  19 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_2010-0702.pdf
... (e.g., therapy, wound care, diabetic training, Care Organization (MCO), request PA minor surgeries.) from and submit claims to the ...
Terms matched: 1  -  Score: 38  -  19 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_2010-1118.pdf
... completed upon the change of supervisor) . 3. The FQHC will notify each MCO of onboarded and dropped CHWs employed within the clinic using the preferred method of ...
Terms matched: 1  -  Score: 69  -  07 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3048_20230407.pdf
... the appropriate Neva- Covered by HMO da Medicaid HMO/Managed Care Organization (MCO) for Plan processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 35  -  03 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2023-03.pdf
... the appropriate Neva- Covered by HMO da Medicaid HMO/Managed Care Organization (MCO) for Plan processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 35  -  31 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2020%20Issue%201_20230331.pdf
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