Nevada Medicaid and Nevada Check Up News (Third Quarter 2023 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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URGENT NOTIFICATION: Physician Administered Drug (PAD) claims may be experiencing a host eligibility error. The impacted claims will be reprocessed automatically. No action is needed by providers.

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, December 3, 2023, 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

Nevada Medicaid COVID-19

Nevada Health Response

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 October 2023 Professional Claims. See Web Announcement 3221.

Top Prior Authorization Denial Reasons for the Third Quarter of 2023. See Web Announcement 3227.

Top 10 Enrollment Return Reasons and Resolutions for First Quarter 2021 Submissions. See Web Announcement 2501.

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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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1. web_announcement_3229_20231201.pdf
... . Electronic 1099s will be available starting with the 2023 tax year. Providers that choose not to obtain their 1099s electronically can also use the EVS Demographic Updates feature ...
Terms matched: 1  -  Score: 21  -  01 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3229_20231201.pdf
2. NV_Billing_General_20230523.pdf
... 2023 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  -  01 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20230523.pdf
3. NV_Billing_General.pdf
... 2023 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  -  30 Nov 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. NV_OPE_User_Manual_Ch2.pdf
... Updated 11/20/2023 (pv10/20/2023) 1. Choose the option that most closely describes the entity you are enrolling. Select the ...
Terms matched: 1  -  Score: 72  -  20 Nov 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_OPE_User_Manual_Ch2.pdf
5. web_announcement_3201_20231030.pdf
... including Fee-For-Service (FFS) recipients and those participating in a Managed Care Organization (MCO) . Prescribers must submit all PA requests to MMA for review and approval ...
Terms matched: 1  -  Score: 38  -  30 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3201_20231030.pdf
6. Known_Issues.pdf
... 1 /2019 6/25/2019 Managed Care, Managed Care Organization (MCO), all details on NDC (National outpatient or outpatient cross-over claims are ...
Terms matched: 1  -  Score: 40  -  12 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
7. web_announcement_3186_20231011.pdf
... EVV system. Essentials to Know: State EVV Sandata Users: If a provider chooses to use the state EVV system through Sandata, they can continue to have ...
Terms matched: 1  -  Score: 37  -  11 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3186_20231011.pdf
8. web_announcement_3184_20231009.pdf
... 13 and 14, 2023, those who reside in a Managed Care Organization (MCO) coverage area were placed back into their last Managed Care Plan that they ...
Terms matched: 1  -  Score: 55  -  09 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3184_20231009.pdf
9. web_announcement_Volume 20 Issue 3_20231002.pdf
... claim to the appropriate by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the re- cipient ...
Terms matched: 1  -  Score: 24  -  02 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2020%20Issue%203_20231002.pdf
10. web_announcement_3175_20230927.pdf
... Medicaid does not place a limit on the number of covered days. The 180-day MCO coverage requirement applies to every nursing facility admission, regardless of the recipient receiving ...
Terms matched: 1  -  Score: 68  -  27 Sep 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3175_20230927.pdf
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