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://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.
|FA-35||Electronic Transaction Agreement for Service Centers|
|FA-36||Service Center Operational Information|
|FA-37||Service Center Authorization|
Trading Partner Enrollment and Certification (Testing) Documents
|Sample Compliant 835 Electronic Remit||Aug. 31, 2018|
|Trading Partner User Guide||Sept. 5, 2018|
|Trading Partner Agreement (TPA)||Aug. 6, 2018|
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.
Provider Billing Manual: EDI Chapter
The EDI chapter in the Provider Billing Manual provides answers to commonly asked EDI questions.
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.
EDI Companion Guides(Use the following Companion Guides until February 2019)
“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)||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.