Nevada Medicaid and Nevada Check Up News (Third Quarter 2017 Provider Newsletter) [Read]

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

The Division of Health Care Financing and Policy (DHCFP) has selected LIBERTY Dental Plan of Nevada (LIBERTY) as the new Managed Care Dental Benefits Administrator (DBA) effective January 1, 2018, to serve recipients enrolled in a Managed Care Organization (MCO).[See Web Announcement 1442]

PCS, Prior Authorization and Web Portal Upgrade Frequently Asked Questions (FAQs) [Review]

Reminder of Requirements Regarding Ordering, Prescribing or Referring Provider on Claims. See Web Announcement 1372

Enrollment Termination Frequently Asked Questions (FAQs) [Review]

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

Sunday
8:00PM - 12:30AM

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.

Mailing Address

Mail claims (CMS-1500, UB and ADA), claim appeals, and other written correspondence to:


Nevada Medicaid
P.O. Box 30042
Reno, NV 89520-3042


For claim appeals, write "Attn: Claim Appeals" on the envelope. For claim inquiries and all other written correspondence, write "Attn: Customer Service" on the envelope.

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@dxc.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")
Fax: (775) 335-8502
E-mail: NVMMIS.EDIsupport@dxc.com

Managed Care Organizations (MCOs)

The Nevada Medicaid and Nevada Check Up contracted Managed Care Organizations (MCOs) are AMERIGROUP Community Care, Health Plan of Nevada and SilverSummit Healthplan.


AMERIGROUP Community Care
Provider Contracting
Phone: (702) 228-1307
Fax: (866) 495-8711
E-mail: nv1provsvcs@amerigroup.com


Provider Customer Service
(for eligibility, claims and pre-certification)
Phone: (800) 424-3730
Fax: (866) 495-8711 (except pre-certification)


Pre-certification
Fax: (800) 964-3627


Provider Self-Service Website
https://providers.amerigroup.com/pages/nv-2012.aspx


Claims Address
AMERIGROUP Community Care
Attn: Nevada Claims
P.O. Box 61010
Virginia Beach, VA 23466-1010


Amerigroup Nevada Member Services
Phone: (800) 600-4441
Website: www.myamerigroup.com/nv


Health Plan of Nevada (HPN)
Provider Relations and Provider Contracting
(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


SilverSummit Healthplan
Provider Contracting
(844) 366-2880
Email: NetworkManagement@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
PO 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
PO Box 30042
Reno, NV 89520-3042
Phone: (877) 638-3472 (select option for "Provider Enrollment")
Fax: (775) 335-8593


Prior Authorization

Prior Authorization
Phone: (800) 525-2395
Fax: (866) 480-9903


Prior Authorization for Dental and Personal Care Aide

Mailing Address:
Nevada Medicaid
"Dental PA" or "PCA PA"
P.O. Box 30042
Reno, NV 89520-3042
Phone: (800) 525-2395
Dental Fax: (855) 709-6848
PCA Fax: (855) 709-6846


Prior Authorization for All Other Service Types (except Pharmacy)
Phone: (800) 525-2395
Fax: (866) 480-9903


Mail prior authorization appeals to:
Nevada Medicaid
Nevada Prior Authorization - Appeals
6511 SE Forbes Ave., Bldg. 283
P.O. Box 19287
Topeka, KS 66619-0287

Pharmacy

Customer Service Center
Pharmacy prior authorization requests
Phone: (855) 455-3311
Fax: (855) 455-3303


Technical Call Center
General pharmacy inquiries
Phone: (866) 244-8554


Pharmacy Web PA
Submit prior authorization requests online for prescription drugs. Select "Pharmacy Web PA Login" from the "Pharmacy" menu on this web site. This will take you to the EVS Login. After login, prescribers will see a link for Pharmacy PA.

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 records are incorrect, please contact Health Management Systems, Inc. (HMS) at:


Mailing Address:
HMS - NV Third Party Liability
P.O. Box 12610
Reno, NV 89510

Phone: (775) 335-1040
Toll Free: (855) 528-2596
Fax: (972) 284-5959
Email: NVTPL@hms.com


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

Electronic Health Records (EHR) Incentive Program

Customer Service Center
CGI Business Services
Phone: (888) 639-3452
Email: NV_Support@NVEHRsupport.com