Nevada Medicaid and Nevada Check Up News (First Quarter 2025 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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For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types 14 and 82:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 9, 2025 – June 16, 2025. Please refer to Web Announcement 3595 for details.

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2025 Professional Claims. See Web Announcement 3616.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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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91. companionguide837P.pdf
... Nevada Medicaid and Nevada Check Up Professional Health Care Claims and Managed Care Organization (MCO) Encounters Nevada Medicaid Management Information System (NV MMIS) State of Nevada ...
Terms matched: 1  -  Score: 223  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P.pdf
92. companionguide837P_hipaa-01-12.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X222A1 Professional health care claims and MCO encounter claims (837P) .... 6-1 7. Payer specific business rules ...
Terms matched: 1  -  Score: 137  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P_hipaa-01-12.pdf
93. companionguide837I_hipaa.pdf
... is up to the trading partner to choose which client software they will use. ... Medicare or this loop for each other MCO payer. Omit Nevada Medicaid coverage information ...
Terms matched: 2  -  Score: 23  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837I_hipaa.pdf
94. companionguide837I_hipaa-0-12.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X223A2 Institutional health care claims and MCO encounter claims (837I) 6-1 7. Payer specific business rules and limitations ...
Terms matched: 1  -  Score: 145  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837I_hipaa-0-12.pdf
95. companionguide837I.pdf
... Nevada Medicaid and Nevada Check Up Institutional Health Care Claims and Managed Care Organization (MCO) Encounter Claims Nevada Medicaid Management Information System (NV MMIS) State of ...
Terms matched: 1  -  Score: 223  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837I.pdf
96. companionguide837D_hipaa-01-12.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X224A2 Dental health care claims and MCO encounter claims (837D)6-1 7. Payer specific business rules and limitations ...
Terms matched: 1  -  Score: 129  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837D_hipaa-01-12.pdf
97. companionguide837D_hipaa.pdf
... is up to the trading partner to choose which client software they will use. ... 19/2015 Removed all references for MCO encounter claims. Added information for Health ...
Terms matched: 2  -  Score: 23  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837D_hipaa.pdf
98. companionguide837D.pdf
... Nevada Medicaid and Nevada Check Up Dental Health Care Claims and Managed Care Organization (MCO) Encounter Claims Nevada Medicaid Management Information System (NV MMIS) State of ...
Terms matched: 1  -  Score: 213  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837D.pdf
99. companionguide834_hipaa.pdf
... Number REF01 Reference 36 38 = Master Policy Number Identification Qualifier REF02 Reference 36 10-digit MCO Atypical Identification Provider Identifier 1000A N1 Sponsor Name N102 Plan Sponsor Name 39 Division ...
Terms matched: 1  -  Score: 24  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide834_hipaa.pdf
100. companionguide834.pdf
... , Cancellations and Audits. It counts all recipients with at least one day of MCO enrollment in the current or subsequent month. Ethnicity Codes The 834 transaction includes ...
Terms matched: 1  -  Score: 100  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide834.pdf
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