Nevada Medicaid and Nevada Check Up News (First Quarter 2018 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]

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Notifications

Urgent: The adjudication of claims for physician-administered drugs submitted last week may be delayed due to a claims processing issue. The claims may pend with edit code 0899 (National Drug Code (NDC) claims are pending during transition period) on remittance advices dated June 22, 2018. This notification will be updated when the issue is resolved and when the claims are processed.

Attention Electronic Billing Trading Partners: Preparations Continue for the Medicaid Management Information System Modernization Project – Inbound Companion Guides Now Available. [See Web Announcement 1617]

Attention All Providers and Electronic Billing Trading Partners: Medicaid Management Information System Enhancements Will Improve Claims and Enrollment Processes. [See Web Announcement 1559]

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]

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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 02/01/2018

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 | Outpatient Mental Health Treatment Plan Fact Sheet 03/28/17
15 Registered Dietitian 12/15/17
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 02/01/17
17 Special Clinics 04/10/18
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. 04/11/18
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 04/11/18
25 Optometrist 04/17/18
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 02/23/18
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 06/20/18
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 04/17/18
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 04/11/18
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) 05/01/18

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