Nevada Medicaid and Nevada Check Up News (Third Quarter 2022 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


Nevada Medicaid COVID-19

Nevada Health Response

Known Modernization System Issues-Click HERE

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

Top 10 Claim Denial Reasons and Resolutions/Workarounds for September 2022 Claims. See Web Announcement 2929.

Top Prior Authorization Denial Reasons for the First Quarter of 2021. See Web Announcement 2505.

Top 10 Enrollment Return Reasons and Resolutions for First Quarter 2021 Submissions. See Web Announcement 2501.

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


Open enrollment occurs annually from October 1 through October 31. During open enrollment a Medicaid recipient can choose a new plan, and that choice will be effective on January 1 of each year.


Details on open enrollment can be found by downloading the "NVMedicaid" application found on the Apple Store, on Google Play, at the MDP weblink at https://mdp.medicaid.nv.gov/, on the DHCFP website at https://dhcfp.nv.gov/Members/BLU/MCOMain/, on the Medicaid website at https://www.medicaid.nv.gov/providers/enrollees/MCOinfo.aspx, or at your local Medicaid District Office at the following numbers: Northern Nevada (775) 687-1900 or Southern Nevada (775) 668-4200.


Sign up for Medicaid Member News: Nevada Medicaid sends notifications over ListServ direct to your email regarding news, initiatives and public meetings. Click https://dhcfp.nv.gov/Resources/NevadaMedicaidUpdate/MemberNewsListserv/ to subscribe.


FAQs for Managed Care Enrollment can be found here: https://dhcfp.nv.gov/Members/BLU/MCOMain/


Benefit Fact Sheets & Contact Info

Medical care in managed care covered areas is provided by the MCOs listed below. You can change your MCO annually during Open Enrollment. Go to your MCO’s website to find a provider.

To review the MCO Benefit Fact Sheets, visit https://dhcfp.nv.gov/Members/BLU/MCOMain/

The form to change your MCO can be found by visiting https://dhcfp.nv.gov/Members/BLU/MCOMain/

Send the completed MCO change form to the following mailing address:
Nevada Medicaid ATTN: MCO Changes PO Box 30042 Reno, NV 89520


Nevada Medicaid and Nevada Check Up contracted Managed Care Organizations (MCOs) Contact Information:

Anthem Blue Cross and Blue Shield Healthcare Solutions
Phone: (844) 396-2329

Health Plan of Nevada (HPN)
Phone: (800) 962-8074

Molina Healthcare of Nevada
Phone: (833) 685-2102

SilverSummit Healthplan
Phone: (844) 366-2880


NCQA's Health Plan Report Cards

National Committee for Quality Assurance (NCQA) evaluates health plans on the quality-of-care patients receive, how happy patients are with their care, and health plans' efforts to keep improving.

To view the NCQA Accreditation status and Health Plan Rating for Nevada MCOs, click the link below: https://reportcards.ncqa.org/health-plans?dropdown-state=Nevada&filter-state=Nevada&filter-plan=Medicaid&pg=1


Dental Benefit Administration (DBA)

When you are enrolled in an MCO, you are automatically enrolled in a DBA as well. Effective January 1, 2018, dental benefits in Nevada are provided by LIBERTY Dental Plan of Nevada, Inc. Go to LIBERTY’s website to find a provider.


LIBERTY Dental Plan of Nevada, Inc.
Phone: (866) 609-0418
Website: www.libertydentalplan.com/NVMedicaid


LIBERTY Dental Plan is fully accredited by URAC.

Achieving Dental Plan Accreditation from the Utilization Review Accreditation Commission (URAC) signals to stakeholders — from patients and providers to potential partners — that your dental plan has fine-tuned its operations and adheres to a set of rigorous quality standards organization-wide.

To view accreditation details, click the link below: https://accreditnet.urac.org/directory/#/accreditation/DPL006099/info