Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2023 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

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time, Tuesday, February 20, 2024, for scheduled maintenance. This maintenance period replaces the maintenance scheduled for Monday, February 19, 2024, due to the Presidents Day Holiday.
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

URGENT NOTIFICATION: Physician Administered Drug (PAD) claims may be experiencing a host eligibility error. The impacted claims will be reprocessed automatically. No action is needed by providers.

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

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 November 2023 Professional Claims. See Web Announcement 3249.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023. See Web Announcement 3280.

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


Important Changes Coming to Nevada Medicaid


If you or a family member currently have health insurance through Medicaid or the Children’s Health Insurance Program (CHIP), you may need to take steps to find out if you can continue your coverage. Soon, the Division of Welfare and Supportive Services (DWSS) will resume Medicaid and CHIP eligibility reviews. This means you could lose coverage. Be sure you receive important notices in the mail by making sure your address is up to date. That way DWSS can contact you about your Medicaid or CHIP coverage. Here is information to help you update your address in English and Spanish.


Check your mail


DWSS may mail you a letter about your Medicaid or CHIP coverage. This letter will also let you know if you need to complete a renewal form to see if you still qualify for Medicaid or CHIP. If you get a renewal form, fill it out and return it to your state right away. This may help you avoid a gap in your coverage.


Update My Address


Nevada Medicaid and the Division of Welfare and Supportive Services have an easy way for members to update their address. Simply follow the link to complete the form https://dhcfp.nv.gov/UpdateMyAddress/


You can also create an account, go paperless, and update your address at Access Nevada (nv.gov)


Member Support https://dhcfp.nv.gov/Members/Home/