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]

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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.

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61. NV_BillingGuidelines_PT11_online_021622.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  05 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_021622.pdf
62. NV_Medicaid_News_2022-1230.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: 36  -  04 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2022-1230.pdf
63. web_announcement_Volume 19 Issue 4_20221230.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: 36  -  30 Dec 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2019%20Issue%204_20221230.pdf
64. web_announcement_2965_20221222.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  22 Dec 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2965_20221222.pdf
65. web_announcement_2929_20221025.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  25 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2929_20221025.pdf
66. NV_Medicaid_News_2022-1013.pdf
... ered by HMO Plan ate Nevada Medicaid HMO/Managed Care Organiza- tion (MCO) for processing. Provider may find out which MCO the recipient be- ...
Terms matched: 1  -  Score: 36  -  19 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2022-1013.pdf
67. web_announcement_Volume 19 Issue 3_20221013.pdf
... ered by HMO Plan ate Nevada Medicaid HMO/Managed Care Organiza- tion (MCO) for processing. Provider may find out which MCO the recipient be- ...
Terms matched: 1  -  Score: 36  -  13 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2019%20Issue%203_20221013.pdf
68. NDC_Frequently_Asked_Questions.pdf
... sections that follow provide details on Fee-For-Service (FFS) and Managed Care Organization (MCO) Claims. Fee-for-service claims Q: Why does Nevada Medicaid require a National ...
Terms matched: 1  -  Score: 189  -  10 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NDC_Frequently_Asked_Questions.pdf
69. nv_billing_ndc_reference.pdf
... and report NDC data for all drug claims covered by contracted Managed Care Organization (MCO) programs. NDC Breakdown An NDC consists of 11 digits separated into 3 ...
Terms matched: 1  -  Score: 23  -  10 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/nv_billing_ndc_reference.pdf
70. web_announcement_2894_20220913.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  13 Sep 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2894_20220913.pdf
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