Nevada Medicaid and Nevada Check Up News (Third Quarter 2018 Provider Newsletter) [Read]

Behavioral Health Providers Invited to Attend Monthly DHCFP Webinars [See Web Announcement 1628]

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 Notice for Behavioral Health Providers: Upcoming Moratorium on Enrollment for Specialty 301 (Qualified Mental Health Associates) and Specialty 302 (Qualified Behavioral Aides) [See Web Announcement 1746]

Modernization: Dates All Providers and Delegates Need to Know to Prepare for Paperless Processes [See Web Announcement 1733]

Modernization: Trading Partner Enrollment and Certification (Testing) Must Be Completed Immediately to Avoid Any Service Interruptions [See Web Announcement 1766]

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

Sunday
8:00PM - 12:30AM

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://portaluat.medicaid.nv.gov/hcp/provider/Home], 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
Fax: (775) 335-8502

EDI Enrollment Forms

EDI enrollment forms are for completion and submission by active or enrolling Nevada Medicaid and Nevada Check Up providers only.

Form Number Title
FA-35 Electronic Transaction Agreement for Service Centers
FA-36 Service Center Operational Information
FA-37 Service Center Authorization
FA-39 Payerpath Enrollment
Trading Partner Enrollment and Certification (Testing) Documents
Title Date
Sample Compliant 835 Electronic Remit Aug. 31, 2018
Trading Partner User Guide Sept. 5, 2018
Trading Partner Agreement (TPA) Aug. 6, 2018
EDI Announcements
Title Date
Payerpath Claim Submission Training for December 2018 Nov. 26, 2018
Payerpath Claim Submission Training for November 2018 Oct. 24, 2018
Payerpath Claim Submission Training for October 2018 Sept. 26, 2018
Payerpath Claim Submission Training for September 2018 Aug. 29, 2018
Payerpath Claim Submission Training for August 2018 Aug. 1, 2018
Payerpath Claim Submission Training for July 2018 June 26, 2018
Payerpath Claim Submission Training for June 2018 May 24, 2018
Payerpath Claim Submission Training for May 2018 Apr. 25, 2018
Payerpath Claim Submission Training for April 2018 Mar. 26, 2018
Payerpath Claim Submission Training for March 2018 Feb. 22, 2018
Payerpath Claim Submission Training for February 2018 Jan. 23, 2018
Payerpath Claim Submission Training for January 2018 Dec. 29, 2017
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
Instructions for EDI Enrollment December 2011
Payerpath

Enrolled providers may submit electronic Nevada Medicaid and Nevada Check Up claims free of charge through Allscripts-Payerpath.

Service Center Directory

The Service Center Directory is a list of commercial clearinghouses currently registered with Nevada Medicaid. The list contains links to each clearinghouse’s web site.

Service Center Directory

Provider Billing Manual: EDI Chapter

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

Read the chapter...

Service Center User Manual

The Service Center User Manual contains technical instructions for submitting and retrieving electronic transactions. This includes SFTP guidelines, transaction testing and handling login problems. EDI registration instructions are also included.

Service Center User Manual

EDI Companion Guides
(Use the following Companion Guides until February 2019)
Title Date
Transaction 270/271 - Health Care Eligibility Inquiry and Response February 2015
Transaction 271U – Unsolicited Transaction – HIPAA Version 5010 February 2013
Transaction 277U - Unsolicited 277 Claims Status Response - HIPAA Version 5010 October 2012
Transaction 820 - Health Care Premium Payment - HIPAA Version 5010 October 2012
Transaction 834 - Benefit Enrollment and Maintenance - HIPAA Version 5010 October 2012
Transaction 835 - Health Care Payment/Advice February 2015
Transaction 837D - Dental Health Care Claim - HIPAA Version 5010 October 2015
Transaction 837I - Institutional Health Care Claim - HIPAA Version 5010 October 2015
Transaction 837P - Professional Health Care Claim - HIPAA Version 5010 October 2015
“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) June 2018
Institutional Health Care Claim: Fee-for-Service (837I) June 2018
Professional Health Care Claim: Fee-for-Service (837P) June 2018
837 Health Care Claim/Encounter: Dental Encounter (837D) September 2018
837 Health Care Claim/Encounter: Institutional Encounter (837I) September 2018
837 Health Care Claim/Encounter: Professional Encounter (837P) September 2018
837 Health Care Claim/Encounter: Non-Emergency Transportation (NET) Professional Encounter (837P) September 2018
National Council for Prescription Drug Program (NCPDP) Encounter Claims Companion Guide June 2018
“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) September 2018
Health Care Claim Status Inquiry and Response (276/277) September 2018
Health Care Premium Payment (820) November 2018
Benefit Enrollment and Maintenance (834) November 2018
Health Care Payment/Advice (835) June 2018

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