Nevada Medicaid and Nevada Check Up News (Third Quarter 2019 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 Notification:
Currently, some providers submitting Group Applications, Group Changes and Group Revalidations do not have the option in the Online Provider Enrollment system to select associated providers or change individual providers associated with the group. This is a known issue and a fix is being researched. In the meantime, providers can complete the Associate Provider list and submit it with the request. Individual applications are not impacted by this issue. The Associate Provider list is available at the following link:
https://www.medicaid.nv.gov
/HCP42/hp/ushc/docs/provider
/Associated%20Providers.pdf


Known Modernization System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2019 Claims. See Web Announcement 1979.

Paper claims are no longer accepted by Nevada Medicaid. Please refer to Web Announcement 1733 and Web Announcement 1829 for additional information.

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

Effective February 1, 2019, all providers will be required to submit their Electronic Data Interchange (EDI) enrollment application electronically via the Provider Web Portal [https://www.medicaid.nv.gov/hcp/provider], as paper EDI application submissions 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.

Electronic billing (also called Electronic Data Interchange or "EDI") speeds payment and eliminates costs associated with paper claims. You can submit electronic claims through a clearinghouse or through your existing, HIPAA-compliant business management software.


If you have any questions, please contact our EDI Coordinator at:
Telephone: (877) 638-3472

Trading Partner Enrollment and Certification (Testing) Documents
Title Date
Sample Compliant 835 Electronic Remit Aug. 31, 2018
Trading Partner User Guide May 10, 2019
Trading Partner Agreement (TPA) Aug. 6, 2018
EDI Announcements
Title Date
Electronic 837I Inpatient Claims with ICD-10 Codes Are Processing Appropriately Feb. 23, 2016
Claim Adjustment Reason Code for Presumptive Payment Adjustment on 837 Electronic Transactions Dec. 21, 2015
It’s 1 month until ICD-10 Codes Must Be Used on Claims with Dates of Service on or after October 1, 2015. Have You Tested to Ensure Claims will be Accepted and Processed? Sept. 1, 2015
ICD-10 Testing Encouraged before Implementation Date July 1, 2015
ICD-10 Testing and Facts Information June 11, 2015
EDI Announcement: Dual Use for 4010/5010 Formats Ends June 30, 2012 June 5, 2012
Anesthesia Services Claims Submitted Electronically (Updated May 31, 2012) May 4, 2012
EDI Announcement: Nevada Medicaid Version 5010 Solution Limits Diagnosis Codes on 837P Transactions. Apr. 30, 2012
EDI Announcement: Prepare for March 31, 2012, End Date for Dual Use of 5010 and D.0 Formats Jan. 25, 2012
Provider Billing Manual: EDI Chapter

The EDI chapter in the Provider Billing Manual provides answers to commonly asked EDI questions.

Read the chapter...

“Inbound” EDI Companion Guides
(The following Companion Guides are valid to use for the certification/testing to transition to the modernized MMIS and upon implementation of the MMIS Modernization Project in February 2019)
Title Date
Dental Health Care Claim: Fee-for-Service (837D) September 2019
Institutional Health Care Claim: Fee-for-Service (837I) September 2019
Professional Health Care Claim: Fee-for-Service (837P) October 2019
837 Health Care Claim/Encounter: Dental Encounter (837D) April 2019
837 Health Care Claim/Encounter: Institutional Encounter (837I) April 2019
837 Health Care Claim/Encounter: Professional Encounter (837P) April 2019
837 Health Care Claim/Encounter: Non-Emergency Transportation (NET) Professional Encounter (837P) April 2019
National Council for Prescription Drug Program (NCPDP) Encounter Claims Companion Guide April 2019
“Outbound” EDI Companion Guides
(The following Companion Guides are valid to use for the certification/testing to transition to the modernized MMIS and upon implementation of the MMIS Modernization Project in February 2019)
Title Date
Health Care Eligibility Benefit Inquiry and Information Response (270/271) April 2019
Health Care Claim Status Inquiry and Response (276/277) April 2019
Health Care Premium Payment (820) April 2019
Benefit Enrollment and Maintenance (834) November 2019
Health Care Payment/Advice (835) March 2019

The Companion Guides contain our HIPAA-compliant technical specifications for each transaction.