Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2020 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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EVS User Manual

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Nevada Medicaid COVID-19

Nevada Health Response

Known Modernization 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 January 2021 Claims. Web Announcement 2425.

Top Prior Authorization Denial Reasons for the Third Quarter of 2020. See Web Announcement 2355.

Top 10 Enrollment Return Reasons and Resolutions for Third Quarter 2020 Submissions. See Web Announcement 2411.

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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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


Billing Information

Effective February 1, 2019, all providers will be required to submit their claims electronically (using Trading Partners or Direct Data Entry [DDE]), as paper claims submission will no longer be accepted with the go-live of the new modernized Medicaid Management Information System (MMIS). Please continue to review the modernization-related web announcements at https://www.medicaid.nv.gov/providers/Modernization.aspx for further details.

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 1711]


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]


COVID-19 Billing Guides
Title Last Update
COVID-19 General Billing Guide 01/13/2021
COVID-19 Community-Based Testing & Vaccination Billing Guide 01/13/2021

Remittance Advice Reference Material
Title Last Update
Claim Error/EOB/ANSI Code Crosswalk 02/05/2021
Accounts Receivable Financial Reason Codes 10/09/2020

Billing Manual
For Archives Click here

Title File Size Last Update
Billing Manual 2 MB 11/17/2020

Billing Guidelines (by Provider Type)
For Archives Click here

Provider Type Title Last Update
10 Outpatient Surgery, Hospital Based | Rates 02/03/20
11 Hospital, Inpatient 02/03/20
12 Hospital, Outpatient 02/03/20
13 Psychiatric Hospital, Inpatient 02/03/20
14 Behavioral Health Outpatient Treatment | Outpatient Mental Health Treatment Plan Fact Sheet 02/24/20
15 Registered Dietitian 12/16/19
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 11/25/19
17 Special Clinics 12/30/19
17 (Spec. 179) Special Clinics: School Based Health Centers (SBHC) 01/25/19
17 (Spec. 181) Special Clinics: Federally Qualified Health Centers (FQHC) 08/30/19
17 (Spec. 188) Special Clinics: Certified Community Behavioral Health Center (CCBHC) | CCBHC Allowable Services | FQHC-CCBHC Allowable Services 10/22/19
17 (Spec. 215) Special Clinics: Substance Abuse Agency Model (SAAM) 02/24/20
19 Nursing Facility 11/25/19
20 Physician, M.D., Osteopath, D.O. 05/04/20
21 Podiatrist 06/27/18
22 Dentist | Attachment A: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements 08/14/20
23 Hearing Aid Dispenser & Related Supplies 06/08/20
24 Advanced Practice Registered Nurses 05/04/20
25 Optometrist 10/04/19
26 Psychologist 07/13/20
27 Radiology and Non-invasive Diagnostic Centers 02/25/20
28 Pharmacy: Billing Manual | Apx. A | Apx. B | Apx. C | Apx. D | Apx. E 01/01/21
29 Home Health Agency and Private Duty Nursing Services 11/25/19
30 Personal Care Services - Provider Agency 01/31/19
32 (Spec. 249) Community Paramedicine 11/04/19
32 (Spec. 932) Ambulance, Air or Ground 04/30/20
33 Durable Medical Equipment (DME), Disposable, Prosthetics 01/07/20
34 Therapy 12/27/19
36 Chiropractor 12/05/11
38 Waiver for Individuals with Intellectual and Developmental Disabilities 01/25/21
39 Adult Day Health Care 03/09/20
41 Optician, Optical Business 10/04/19
43 Laboratory, Pathology Clinical 06/09/20
44 Swing-bed, Acute Hospital 11/25/19
45 End Stage Renal Disease (ESRD) Facility 02/03/21
46 Ambulatory Surgical Centers 12/30/19
47 Indian Health Services (IHS) and Tribal Clinics 05/01/20
48 Home and Community Based Waiver for the Frail Elderly 01/25/21
51 Indian Health Service Hospital, Inpatient (Tribal) 12/02/19
52 Indian Health Service Hospital, Outpatient (Tribal) 12/02/19
54 Targeted Case Management 06/17/20
55 Day and Residential Habilitation Services 05/18/20
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 12/03/19
57 Home and Community Based Waiver for the Frail Elderly in Residential Facilities for Groups 01/25/21
58 Home and Community Based Waiver for Persons with Physical Disabilities 01/25/21
59 Home and Community Based Waiver for the Frail Elderly in an Assisted Living Facility 01/25/21
60 School Health Services (SHS) 08/06/20
63 Residential Treatment Centers (RTC) 12/10/20
64 Hospice 12/03/19
65 Hospice, Long Term Care 12/03/19
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Private 11/25/19
72 Nurse Anesthetist 12/05/11
74 Nurse Midwife 05/31/19
75 Critical Access Hospital (CAH), Inpatient 12/16/19
76 Audiologist 06/08/20
77 Physician's Assistant 05/04/20
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 12/02/19
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 12/02/19
81 Hospital Based ESRD Provider 02/03/21
82 Behavioral Health Rehabilitative Treatment 02/01/19
83 Personal Care Services - Intermediary Service Organization 01/31/19
85 Applied Behavior Analysis (ABA) 01/23/20
86 Specialized Foster Care | Specialized Foster Care Needs Based Eligibility Checklist 01/13/21

Billing Instructions (by Service Type)
Title Last Update
Anesthesia 06/05/20
Medication-Assisted Treatment (MAT) Services for Opioid Dependence 07/10/20
Preventive Services 05/04/20
Sterilization and Abortion Policy 03/10/20
Telehealth 11/18/20