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]

Notifications


Nevada Medicaid COVID-19

Nevada Health Response

The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, January 24, 2021, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS)
  • Online Provider Enrollment (OPE)
  • Online Provider Claim Appeals
  • Online Prior Authorization (PA) system
  • Online Claims Submission
  • Audio Response System (ARS) (800-942-6511)
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR


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 December 2020 Claims. See Web Announcement 2405.

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.

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

To see which documents must be submitted with your Provider Enrollment Packet, click the name of your provider type(s) in the list below. If your provider type is not in the list below, please contact the Provider Enrollment Unit at (877) 638-3472 for requirements.

Note: Out of state providers must also submit proof of Medicaid eligibility in the state that services are/were rendered.

Provider Type Title Updated Date
10 Outpatient Surgery, Hospital Based 01/27/20
11 Hospital, Inpatient 07/25/19
12 Hospital, Outpatient 01/27/20
13 Psychiatric Hospital, Inpatient 07/25/19
14 Behavioral Health Outpatient Treatment n/a
15 Registered Dietitian 07/25/19
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities, Public 08/12/19
17 Special Clinics n/a
19 Nursing Facility 08/12/19
20 Physician, M.D., Osteopath, D.O. 09/22/20
21 Podiatrist 09/22/20
22 Dentist 09/22/20
23 Hearing Aid Dispenser & Related Supplies 07/25/19
24 Advanced Practice Registered Nurse 12/02/20
25 Optometrist 07/25/19
26 Psychologist n/a
27 Radiology and Non-invasive Diagnostic Centers 06/24/20
28 Pharmacy 08/12/19
29 Home Health Agency 07/25/19
30 Personal Care Services - Provider Agency 06/15/20
32 (Spec. 249) Community Paramedicine 11/04/19
32 (Spec. 932) Ambulance, Air or Ground 11/04/19
33 Durable Medical Equipment, Prosthetics, Orthotics and Disposable Medical Supplies (DMEPOS) 08/29/19
34 Therapy n/a
36 Chiropractor 07/25/19
38 Home & Community Based Waiver – Individuals with Intellectual Disabilities and Related Conditions n/a
39 Adult Day Health Care Center 12/09/20
41 Optician, Optical Business, Ocularist 08/01/19
43 Laboratory, Pathology Clinical 11/24/20
44 Swing-bed, Acute Hospital 11/04/20
45 End Stage Renal Disease (ESRD) Facility 11/04/20
46 Ambulatory Surgical Centers, Freestanding 11/04/20
47 Indian Health Programs and Tribal Clinics 05/01/20
48 Home and Community Based Services Waiver for the Frail Elderly n/a
51 Indian Health Service Hospital, Inpatient (Tribal) 11/24/20
52 Indian Health Service Hospital, Outpatient (Tribal) 11/24/20
54 Targeted Case Management 05/17/19
55 Habilitation 03/09/20
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 08/05/19
57 Home and Community Based Services Waiver for the Elderly in Adult Residential Care 08/29/19
58 Waiver for Persons with Physical Disabilities (“PD”) n/a
59 Home and Community Based Services Waiver for the Elderly – Augmented Personal Care Services 08/29/19
60 School Based 08/05/19
63 Residential Treatment Center (RTC) 08/29/19
64 Hospice 08/05/19
65 Hospice, Long Term Care 08/05/19
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities, Private 08/05/19
72 Nurse Anesthetist 07/24/19
74 Nurse Midwife 12/02/20
75 Critical Access Hospital (CAH), Inpatient 11/24/20
76 Audiologist n/a
77 Physician's Assistant 07/24/19
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 08/02/19
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 08/02/19
81 Hospital Based End Stage Renal Disease (ESRD) Provider 08/29/19
82 Behavioral Health Rehabilitative Treatment n/a
83 Personal Care Services - Intermediary Service Organization 06/15/20
85 Applied Behavior Analysis (ABA) n/a
86 Specialized Foster Care 01/13/21

If you have any questions, please contact the Provider Enrollment Unit at (877) 638-3472 from 8:00AM to 5:00PM, Monday through Friday.