Nevada Medicaid and Nevada Check Up News (Second Quarter 2017 Provider Newsletter) (Updated August 4, 2017) [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]

Featured Links

Authorization Criteria

DHCFP Home

EDI Enrollment Forms and Information

EVS User Manual

Online Provider Enrollment

Provider Login (EVS)

Prior Authorization

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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]

The Nevada Medicaid Provider Web Portal (PWP) Upgrade has been implemented. With this upgrade, Dental/Orthodontia, Adult Day Health Care (ADHC) and Personal Care Services (PCS) providers can generate a prior authorization request via the Provider Web Portal.[See Web Announcement 1415]

The Nevada Provider Web Portal update resulted in a complete change in the website and its associated webpages. Users of the secure Provider Web Portal are advised to remove all previously bookmarked pages and clear any previous activity in your browser to assist with accessing the system. You can clear previous activity in most browsers by navigating to your menu item for internet or browser options and deleting cookies, temporary internet files, and web form information.

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]

Provider Links

Billing Information

E-Prescribing

Forms

Provider Enrollment

Provider Newsletters

Provider Training

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

Billing Information

ICD-10 Codes Must Be Used on Claims with Dates of Service on or after October 1, 2015. Are You Ready?

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Web Announcement 850]

ICD-10 Frequently Asked Questions [Review Now]

FAQs: National Correct Coding Initiative (NCCI) Claim Review Edits [Review Now]

Clinical Claim Editor FAQs Updated December 5, 2011 [Review Now]

Third Party Liability Frequently Asked Questions [Review Now]

Paper Claim Form Instructions

The following instructions are for paper claims. For electronic claim requirements, technical professionals can refer to Companion Guides for transactions 837D, 837I and 837P.

For Archives Click here

Title Last Update
ADA (Version 2012) Claim Form Instructions 01/28/16
CMS-1500 (02-12) Claim Form Instructions 07/27/17
UB Claim Form Instructions 05/30/17

Billing Manual
For Archives Click here

Title File Size Last Update
Billing Manual 2 MB 09/01/2017

Billing Guidelines (by Provider Type)
For Archives Click here

Provider Type Title Last Update
10 Outpatient Surgery, Hospital Based | Rates 07/24/17
11 Hospital, Inpatient 10/07/16
12 Hospital, Outpatient 10/01/15
13 Psychiatric Hospital, Inpatient 02/01/12
14 Behavioral Health Outpatient Treatment 03/28/17
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 02/01/17
17 Special Clinics 08/17/17
17 (Spec. 179) Special Clinics: School Based Health Centers (SBHC) 12/31/14
17 (Spec. 215) Special Clinics: Substance Abuse Agency Model (SAAM) 04/21/15
19 Nursing Facility 02/01/12
20 Physician, M.D., Osteopath, D.O. 08/17/17
21 Podiatrist 12/05/11
22 Dentist | Attachment A: Coverage, Limitations and Prior Authorization Requirements 07/24/17
23 Hearing Aid Dispenser & Related Supplies 01/03/13
24 Advanced Practice Registered Nurses 08/17/17
25 Optometrist 02/01/12
26 Psychologist 09/11/15
27 Radiology & Non-invasive Diagnostic Centers 08/18/14
28 Pharmacy: Billing Manual | Apx. A | Apx. B | Apx. C | Apx. D | Apx. E 04/12/17
29 Home Health Agency 07/24/17
30 Personal Care Services - Provider Agency 02/06/13
32 Ambulance, Air or Ground 10/25/16
33 Durable Medical Equipment (DME), Disposable, Prosthetics 07/24/17
34 Therapy 07/24/17
36 Chiropractor 12/05/11
38 Waiver for Individuals with Intellectual Disabilities and Related Conditions 08/04/17
39 Adult Day Health Center 07/24/17
41 Optician, Optical Business 02/01/12
43 Laboratory, Pathology Clinical 03/22/17
44 Swing-bed, Acute Hospital 10/08/13
45 End Stage Renal Disease (ESRD) Facility 04/03/15
46 Ambulatory Surgical Centers | Rates 07/24/17
47 Indian Health Services (IHS) and Tribal Clinics 10/02/15
48 Home and Community Based Waiver for the Frail Elderly 03/16/16
51 Indian Health Service Hospital, Inpatient (Tribal) 12/05/11
52 Indian Health Service Hospital, Outpatient (Tribal) 12/05/11
54 Targeted Case Management 03/28/17
55 Home Based Habilitation Services 03/16/16
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 02/23/16
57 Home and Community Based Waiver for the Frail Elderly (Elderly in Adult Residential Care) 03/16/16
58 Home and Community Based Waiver for Persons with Physical Disabilities 03/16/16
59 Home and Community Based Waiver for the Frail Elderly (Augmented Personal Care Services) 03/16/16
60 School Based 03/22/17
63 Residential Treatment Centers (RTC) 07/24/17
64 Hospice | Reimbursement Rates | Reimbursement Rates - Non compliant 09/25/17
65 Hospice, Long Term Care 09/25/17
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Private 02/01/17
72 Nurse Anesthetist 12/05/11
74 Nurse Midwife 07/11/12
75 Critical Access Hospital (CAH), Inpatient 10/01/15
76 Audiologist 01/03/13
77 Physician's Assistant 08/17/17
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 12/05/11
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 12/05/11
81 Hospital Based ESRD Provider 04/03/15
82 Behavioral Health Rehabilitative Treatment 01/15/16
83 Personal Care Services - Intermediary Service Organization 02/06/13
85 Applied Behavior Analysis (ABA) 07/24/17

Billing Instructions (by Service Type)
Title Last Update
Anesthesia 12/05/11
Sterilization and Abortion Policy 03/06/14
Telehealth 08/11/16