Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2023 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

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time, Tuesday, February 20, 2024, for scheduled maintenance. This maintenance period replaces the maintenance scheduled for Monday, February 19, 2024, due to the Presidents Day Holiday.
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

URGENT NOTIFICATION: Physician Administered Drug (PAD) claims may be experiencing a host eligibility error. The impacted claims will be reprocessed automatically. No action is needed by providers.

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

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 November 2023 Professional Claims. See Web Announcement 3249.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023. See Web Announcement 3280.

Top 10 Enrollment Return Reasons and Resolutions for First Quarter 2021 Submissions. See Web Announcement 2501.

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 05/04/23
11 Hospital, Inpatient 05/11/23
12 Hospital, Outpatient 05/04/23
12 (Spec. 250) Hospital, Outpatient - Crisis Stabilization Center 02/23/22
13 Psychiatric Hospital, Inpatient 06/16/23
14 Behavioral Health Outpatient Treatment n/a
15 Registered Dietitian 03/01/23
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities, Public 08/12/19
17 Special Clinics n/a
19 Nursing Facility 05/18/23
20 Physician, M.D., Osteopath, D.O. 11/28/23
21 Podiatrist 11/28/23
22 Dentist 11/28/23
23 Hearing Aid Dispenser & Related Supplies 05/14/21
24 Advanced Practice Registered Nurse 12/02/20
25 Optometrist 05/24/21
26 Psychologist n/a
27 Radiology and Non-invasive Diagnostic Centers 06/16/23
28 Pharmacy 08/06/21
29 Home Health Agency 05/18/23
30 Personal Care Services - Provider Agency 01/17/24
32 (Spec. 249) Community Paramedicine 11/04/19
32 (Spec. 932) Ambulance, Air or Ground 08/04/21
33 Durable Medical Equipment, Prosthetics, Orthotics and Disposable Medical Supplies (DMEPOS) 05/12/23
34 Therapy n/a
35 (Spec. 987) Non-Emergency Secure Behavioral Health Transports 07/19/21
36 Chiropractor 05/28/21
38 Home & Community Based Services (HCBS) Waiver for Individuals with Intellectual and Developmental Disabilities n/a
39 Adult Day Health Care Center 12/09/20
41 Optician, Optical Business, Ocularist 06/08/21
43 Laboratory, Pathology Clinical 06/16/23
44 Swing-bed, Acute Hospital 11/29/23
45 End Stage Renal Disease (ESRD) Facility 11/29/23
46 Ambulatory Surgical Centers, Freestanding 11/29/23
47 Indian Health Programs and Tribal Clinics 03/15/22
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 06/26/23
55 Habilitation 03/09/20
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 05/11/23
57 Home and Community Based Services Waiver for the Elderly in Adult Residential Care 08/29/19
57 (Spec.303) Home and Community Based Services Waiver for the Elderly in Adult Residential Care - Private Case Management Services 04/07/23
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
59 (Spec.303) Home and Community Based Services Waiver for the Elderly - Augmented Personal Care Services - Private Case Management Services 04/07/23
60 School Based 08/05/19
63 Residential Treatment Center (RTC) 06/28/23
64 Hospice 05/18/23
65 Hospice, Long Term Care 05/18/23
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities, Private 08/05/19
72 Nurse Anesthetist 05/12/21
74 Nurse Midwife 12/02/20
75 Critical Access Hospital (CAH), Inpatient 05/12/23
76 Audiologist n/a
77 Physician's Assistant 05/17/21
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 05/05/23
82 Behavioral Health Rehabilitative Treatment n/a
83 Personal Care Services - Intermediary Service Organization 01/17/24
85 Applied Behavior Analysis (ABA) n/a
86 Specialized Foster Care 07/30/21
89 Community Health Workers 02/22/22
90 Doula Services 03/31/22
91 Pharmacist 06/30/22
94 Medicare Cost-Sharing 03/21/23

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