Nevada Medicaid and Nevada Check Up News (First Quarter 2024 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

URGENT Electronic Visit Verification (EVV) Claims Message: EVV claims submitted through Sandata between noon Pacific Time on Monday, April 8, 2024, and 6 a.m. Pacific Time on Tuesday, April 9, 2024, were received for processing by Gainwell on Wednesday, April 17, 2024. As a result, payment of the impacted claims will be unfortunately delayed by one week and paid April 26, 2024, instead of April 19, 2024. No action is required on your part. Nevada Medicaid is working to avoid this happening again in the future and apologizes for the inconvenience this payment delay causes during this period of EVV claim submission challenges because of the Change Healthcare cyber security event.

URGENT Electronic Visit Verification (EVV) Claims Message: EVV claims submitted through Sandata after noon Pacific Time last Thursday, April 4, 2024, were received for processing by Gainwell on Monday, April 8, 2024. As a result, payment of the impacted claims will be unfortunately delayed by one week and paid April 19, 2024, instead of April 12, 2024. No action is required on your part. Nevada Medicaid is working with Sandata to avoid this happening again in the future and apologizes for the inconvenience this payment delay causes during this period of EVV claim submission challenges because of the Change Healthcare cyber security event.

Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Please be advised that claims must be submitted before noon Pacific Time on Fridays to be included in the following weeks’ remittance advice.

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

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 specialty in the list below. Out of state providers must also submit proof of Medicaid eligibility in the state that services are/were rendered.

Specialty Description Updated Date
882 Behavioral Health Rehabilitative Treatment Entity/Agency/Group 06/24/2020
300 Qualified Mental Health Professional (QMHP) 07/28/2022
301 Qualified Mental Health Associate (QMHA) 02/26/2024
302 Qualified Behavioral Aide (QBA) 02/26/2024

Return to Provider Enrollment Checklists page.

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