Electronic Claims / EDI
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
|Sample Compliant 835 Electronic Remit||Aug. 31, 2018|
|Trading Partner User Guide||Feb. 1, 2019|
|Trading Partner Agreement (TPA)||Aug. 6, 2018|
Provider Billing Manual: EDI Chapter
The EDI chapter in the Provider Billing Manual provides answers to commonly asked EDI questions.
“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)
“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)
|Health Care Eligibility Benefit Inquiry and Information Response (270/271)||September 2018|
|Health Care Claim Status Inquiry and Response (276/277)||April 2019|
|Health Care Premium Payment (820)||April 2019|
|Benefit Enrollment and Maintenance (834)||April 2019|
|Health Care Payment/Advice (835)||March 2019|
The Companion Guides contain our HIPAA-compliant technical specifications for each transaction.