Nevada Medicaid and Nevada Check Up News (Third 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


Unwinding COVID-19 Information

Known System Issues-Click HERE

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 September 2024 Professional Claims. See Web Announcement 3465.

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

General Information

Customer Service Center
Claim inquiries and general information
Mailing Address:
Nevada Medicaid
Customer Service
P.O. Box 30042
Reno, NV 89520-3042
Phone: (877) 638-3472


Nevada Medicaid Central Office
State policy inquiries and Fair Hearing requests
Mailing Address:
1100 East William St.
Suite 102
Carson City, NV 89701
Phone: (877) 638-3472 and (775) 684-3600


Medicaid Recipient Customer Service
Las Vegas District Office: (702) 668-4200
Reno District Office: (775) 687-1900
All other areas: (866) 569-1746


Automated Response System (ARS)
Recipient eligibility, recent payments, claim status, and prior authorization information via phone
Phone: (800) 942-6511


Electronic Verification System (EVS)
Recipient eligibility, claim status, prior authorization status, provider payments

Note: For EVS, there can only be one provider administrator for each NPI/FEIN/zip code. The provider administrator must register as a “Provider” and will be responsible for creating delegates for that provider. If you do not know who is the provider administrator is in your office, call the Customer Service Center at (877) 638-3472.

Web Sites

Nevada Medicaid Web Site
Web announcements, billing manual, billing guidelines, forms, pharmacy information

https://www.medicaid.nv.gov


DHCFP Web Site
Medicaid Services Manual, rates, policy updates, public notices

http://dhcfp.nv.gov

Provider Training

Mailing Address:
Nevada Medicaid
Provider Training
P.O. Box 30042
Reno NV 89520-3042
E-mail: NevadaProviderTraining@gainwelltechnologies.com

Electronic Billing

Mailing Address:
Nevada Medicaid
EDI Coordinator
P.O. Box 30042
Reno, NV 89520-3042
Phone: (877) 638-3472 (select option for "Electronic Billing")
E-mail: NVMMIS.EDIsupport@gainwelltechnologies.com

Managed Care Organizations (MCOs)

The Nevada Medicaid and Nevada Check Up contracted Managed Care Organizations (MCOs) are Anthem Blue Cross and Blue Shield Healthcare Solutions, Health Plan of Nevada and SilverSummit Healthplan. LIBERTY Dental Plan of Nevada is the Dental Benefits Administrator (DBA).


Anthem Blue Cross and Blue Shield Healthcare Solutions
Provider Website: https://providers.anthem.com/nevada-provider/home
Provider Services Phone: 844-396-2330
Provider Contracting: https://providers.anthem.com/nevada-provider/join-our-network


Claims: https://providers.anthem.com/nevada-provider/claims
Payor ID: 00265
Mailing Address:
Anthem Blue Cross and Blue Shield Healthcare Solutions
Attn: Nevada Claims
P.O. Box 61010
Virginia Beach, VA 23466-1010


Precertification: https://providers.anthem.com/nevada-provider/resources/precertification-requirements

Member Services Phone: 844-396-2329
Member Website: https://mss.anthem.com/nevada-medicaid/home.html


Health Plan of Nevada (HPN)
Provider Relations and Provider Contracting
Phone: (702) 242-7088 or (800) 745-7065


Website: https://myhpnmedicaid.com/Provider


Member Services
Phone: (800) 962-8074
Fax: (702) 240-6281


Claims Address
Health Plan of Nevada
P.O. Box 15645
Las Vegas, NV 89114


EDI Claims Submission Clearinghouse:
OptumInsight
1755 Telstar Drive #400
Colorado Springs, CO 80920


Payor ID’s:
Claims – Payor ID 76342
Encounter Data – Payor ID 76343


LIBERTY Dental Plan of Nevada
Provider Relations and Provider Contracting
Phone: (888) 700-0643
Email: prinquiries@libertydentalplan.com
Website: www.libertydentalplan.com/NVMedicaid


Member Services
Phone: (866) 609-0418
Website: www.libertydentalplan.com/NVMedicaid


Claims Address
LIBERTY Dental Plan of Nevada
Attn: Claims
P.O. Box 401086
Las Vegas, NV 89140


Payor ID: CX083


Molina Healthcare of Nevada, Inc.
Provider Contracting
Phone: (833) 685-2103
Email: MHNVProviderContracting@molinahealthcare.com
Fax: (833) 908-4412


Provider Website
Website: https://www.molinahealthcare.com/providers/nv/medicaid/home.aspx


Member Services
Phone: (833) 685-2102


Claims Submission
Website: https://www.molinahealthcare.com/providers/nv/medicaid/claims/submission.aspx


EDI Claims Submission Clearinghouse:
Change Healthcare
Payer ID: MLNNV


Claims Address
Molina Healthcare of Nevada, Inc.
P.O. Box 22666
Long Beach, CA 90801


SilverSummit Healthplan
Provider Contracting
Phone: (844) 366-2880
Email: NetworkManagement@SilverSummitHealthPlan.com
Website: https://www.silversummithealthplan.com


Provider Inquiry Telephone Numbers
Medical/Behavioral Health: (844) 366-2880
Pharmacy: (844) 366-2880
Pharmacy (Prior Authorization): (855) 565-9520
Vision: (855) 896-8572


Claims Addresses
Medical/Behavioral Health:
P.O. Box 5090
Farmington, MO 63640


Pharmacy:
5 River Park Place E, Suite 210:
Fresno, CA 93720


Vision:
Attn: Claims Processing
P.O. Box 7548
Rocky Mount, NC 27804


Fax Numbers
Prior Authorization Requests: Medical: (844) 367-7022 Behavioral Health: (855) 868-4940 Pharmacy: (866) 399-0929
Medical Records (for nurse use) (844) 518-7889
Admissions Census/Facesheets (844) 868-7399
Concurrent Review (844) 755-1370
Case Management (844) 851-1023
Medical Management General (844) 367-7015
Nevada Quality Improvement (855) 565-9517
Nevada Grievance and Appeals (855) 742-0125

Provider Enrollment

Mailing Address:
Nevada Medicaid
Provider Enrollment
P.O. Box 30042
Reno, NV 89520-3042
Phone: (877) 638-3472 (select option for "Provider Enrollment")


Prior Authorization

Prior Authorization
Phone: (800) 525-2395


Prior Authorization for Dental

Nevada Medicaid
"Dental PA"
P.O. Box 30042
Reno, NV 89520-3042
Phone: (800) 525-2395


Prior Authorization for All Other Service Types (except Pharmacy)
Phone: (800) 525-2395

Pharmacy

Customer Service Center
Pharmacy Prior Authorization and Technical Call Center
Phone: (800) 695-5526


Medicaid Customer Service
Medicaid Recipient Inquiries
Phone: (702) 668-4200 or (775) 687-1900


Magellan Medicaid Administration (MMA)
Submit prior authorization requests online for prescription drugs. Select "Magellan Medicaid Administration (MMA)" from the "Pharmacy" menu on this web site or visit Magellan at https://nevadamedicaid.magellanrx.com/home.

Public Hearings

Providers are welcome to attend public hearings and voice their opinion on policy changes. Call the number below to receive electronic or written notices of scheduled public hearings.

Phone: (775) 684-3681

PASRR/LOC

Phone: (800) 525-2395
Fax: (855) 709-6847

Third Party Liability (TPL) Identification and Recovery

If you believe a recipient's private insurance or Medicare Replacement records are incorrect, please contact Health Management Systems, Inc. (HMS) at:


Third Party Referral (TPR)
Only TPL update, add and termination requests:
Toll Free: (855) 528-2596

Email: nvtpl@gainwelltechnologies.com
NOTE: When emailing HMS, “escalation” should be included in the subject line and the email request must include Recipient Name, Date of Birth (DOB), Medicaid ID, and commercial policy information.

Direct Bill and Commercial Insurance
(888) 831-2715

Medicare Disallowance
(877) 640-3420
Email: prdoc@gainwelltechnologies.com

Casualty/Subrogation
(888) 378-2836
Email: NVCasualty@gainwelltechnologies.com

Health Insurance Premium Payment Program (HIPP)
(877) 640-3413
Email: mynvhippcustomerservice@gainwelltechnologies.com

Credit Balance Audit (CBA)
(469) 897-4918
Email: CBANevadaMedicaid@gainwelltechnologies.com

Payment Analytics (PA)
(877) 248-8523
Provider Portal: https://hmsportal.hms.com


If you believe a recipient's Medicare record is incorrect, please contact the DHCFP at:
Email: TPL@dhcfp.nv.gov