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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NOTIFICATION:The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, June 29, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
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Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

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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111. Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
... the guidelines regarding the specific CSFs within the class. The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
112. CMS-1500_Instructions_posted_2011-12-05_through_2013-05-14.pdf
... ER visit payment 1048 Primary carrier has paid full charges 1072 Newborn/Mother in MCO, bill MCO 1049 Recipient not eligible 1073 Credit balance process 1050 Services not ...
Terms matched: 1  -  Score: 25  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/CMS-1500_Instructions_posted_2011-12-05_through_2013-05-14.pdf
113. Clinical_Material_2016-0411.pdf
... guidelines regarding the specific CSFs within the class. o The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Clinical_Material_2016-0411.pdf
114. CMS Payerpath Training 2016-1205.pdf
... | Email: nvmmis.edisupport@dxc.com 19 Claims List Filter Select Form: Type Professional Choose from Untransmitted (claims not yet sent) or Transmitted (claims that have ...
Terms matched: 1  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/CMS%20Payerpath%20Training%202016-1205.pdf
115. Claims_and_PA_Conference_Presentation.pdf
... €œSubmitâ€Nevada Medicaid Provider Training 58 Delegate Assignment, continued †' Choose the Functions you want the delegate to be able to perform †' ...
Terms matched: 1  -  Score: 25  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Claims_and_PA_Conference_Presentation.pdf
116. Botulinum_Toxins_2013-1218.pdf
... of Lower bladder retraining or habit retraining) . Urinary Tract • When choosing a behavioral management program, take into account Dysfunction that prompted voiding and habit ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Botulinum_Toxins_2013-1218.pdf
117. Botulinum Toxins.pdf
... of Lower bladder retraining or habit retraining) . Urinary Tract • When choosing a behavioral management program, take into account Dysfunction that prompted voiding and habit ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Botulinum%20Toxins.pdf
118. Binder_DUR_2019_0124.pdf
... really be controlled by the clinician who chooses to administer the product in his or ... : It would help to know which MCO you’re referring to. ...
Terms matched: 2  -  Score: 277  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2019_0124.pdf
119. Binder_DUR_2018_1018.pdf
... unfortunately similar to what the other ones are. After seeing their recommendations from the MCO as saying that they would just like to keep this criteria. Chapter 1200 ...
Terms matched: 1  -  Score: 59  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2018_1018.pdf
120. Binder_DUR_2018_0726.pdf
... what the choices between which agent to choose. There is no preference for the ... is when Medicaid recipient transfers from one MCO to another? Jim Marx: Right ...
Terms matched: 2  -  Score: 128  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2018_0726.pdf
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