Nevada Medicaid and Nevada Check Up News (First Quarter 2024 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

Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Please be advised that claims must be submitted before noon Pacific Time on Fridays to be included in the following weeks’ remittance advice.

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 April 2024 Professional Claims. See Web Announcement 3361.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

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

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

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DateAnnouncement NumberTopic
Jun 12, 20243374Reminders for Billing Outpatient Drugs for 340B-Covered Entities
Jun 10, 20243373Attention All Providers Billing Dental Services: 5% Rate Increase Approved for Dental Services
Jun 07, 20243372Attention Provider Type 60 (School Health Services): Update on Funding for School Services
Jun 05, 20243371Attention Provider Type (PT) 17 (Special Clinics) Specialty 188 (Certified Community Behavioral Health Center (CCBHC)): Bill Procedure Code T1040 to Recipient’s Correct Benefit Plan
Jun 04, 20243370Nevada Medicaid Updates Reimbursement of Commercial NDC-Labeled Paxlovid®
Jun 03, 20243369Reminders for Providers Whose Nevada Medicaid Contracts Are Terminated for Failure to Revalidate
Jun 03, 20243368Nevada Medicaid Updates Reimbursement of COVID-19 Vaccines
May 29, 20243367Nevada Medicaid Updates Vaccine Administration Reimbursement (Updated May 30, 2024)
May 29, 20243366Attention Provider Type 33 (Durable Medical Equipment, Prosthetics, Orthotics and Supplies): Default Rate for Burn Garment Procedure Codes
May 24, 20243365Attention All Providers: Inactive Providers May Be Subject to Termination
May 24, 20243364Attention Electronic Visit Verification (EVV) Providers: Units of Measure Rule Updated
May 23, 20243363Attention Provider Type (PT) 17 (Special Clinics) Specialties 171 (Methadone) and 215 (Substance Use Agency Model (SUAM)): Upcoming Training Sessions in June 2024 for New PT 93 (Substance Use Treatment) (Updated June 14, 2024)
May 22, 20243362New Provider Type (PT) 93 (Substance Use Treatment (SUT)) Established to Replace PT 17 (Special Clinics) Specialties 171 (Methadone) and 215 (Substance Use Agency Model (SUAM)) and Create New Specialties under PT 93
May 22, 20243361Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for April 2024 Professional Claims
May 22, 20243360Claims for Global Procedure Codes Billed With Modifier TC or Modifier 26
May 21, 20243359Attention Provider Type 25 (Optometrist): Update on Claims for Procedure Codes 92060, 92081, 92082 and 92083
May 21, 20243358Attention Provider Type 22 (Dentist): 5% Rate Increase Approved for Dental Services for Recipients on the Intellectual and Developmental Disabilities (ID) Waiver
May 21, 20243357Attention All Providers: Respiratory Syncytial Virus (RSV) Vaccine and Vaccine Administration Procedure Codes Have Been Opened for Certain Provider Types
May 20, 20243356Attention Provider Type 12 (Hospital, Outpatient): Update on Claims for Procedure Code 98940
May 20, 20243355Attention Inpatient Hospital and Nursing Facility Providers: Reminders for Submission of Pre-Admission Screening Resident Review (PASRR) and Level of Care (LOC) Requests
May 17, 20243354Attention All Providers, Delegates and Staff: Upcoming Training Sessions for June 2024 (Updated June 3, 2024)
May 13, 20243353Attention Provider Type 22 (Dentist): Claims for Recipients Under the Waiver for Individuals with Intellectual and Developmental Disabilities Benefit That Denied Have Been Reprocessed
May 13, 20243352Attention Provider Type 85 (Applied Behavior Analysis (ABA)): Professional Claims Paid in Error or Denied With Error Code 5716 Have Been Reprocessed
May 10, 20243351COVID-19 UNWIND: Recipient Redetermination Dates No Longer Available to Providers
May 09, 20243350Attention All Providers: Top Enrollment Return Reasons and Resolutions for January 2024 Submissions
May 07, 20243349Attention All Providers: Update Regarding Adjudication of Claims Submitted With Ordering, Prescribing or Referring (OPR) Provider
May 07, 20243348Limitations for Nebulizer Procedure Codes Updated in Medicaid Management Information System
May 03, 20243347Attention Provider Types 19 (Nursing Facility) and 65 (Hospice, Long Term Care): State Fiscal Year 2024 Quarter 4 Rate Updates Implemented
May 02, 20243346Urgent Announcement: Adjustment Claims Overpayments
May 02, 20243345Attention All Providers: Invitation to Participate in New Initiatives to Assist with Correctional Facility Transitions to Community Settings
May 01, 20243344Attention Provider Type 17 (Special Clinics) Specialty 188 (Certified Community Behavioral Health Center (CCBHC): Update Regarding Claims Denied for Overlapping Dates of Service
May 01, 20243343Medicaid Management Information System Updated with NCCI Quarter 2 2024 Files
Apr 29, 20243342Claim Appeals Submission Deadline
Apr 25, 20243341Attention Provider Type 63 (Residential Treatment Center/Psychiatric Residential Treatment Facility): Notice of Transition to Federal Requirements for Psychiatric Residential Treatment Facilities (PRTFs)
Apr 23, 20243340Attention All Providers, Delegates and Staff: Upcoming Training Sessions for May 2024
Apr 23, 20243339Second Claim Reprocessing Effort for Physician-Administered Drug (PAD) Claims With Host Eligibility Error
Apr 23, 20243338Attention Billing Provider Type 20 (Physician, M.D., Osteopath, D.O.): Claims That Paid In Error Have Been Reprocessed
Apr 22, 20243337Wegovy (semaglutide) Coverage Updates Based on New FDA-Labeled Indication
Apr 18, 20243336Nevada Medicaid Proposes Transformation of Children’s Behavioral Health Care
Apr 17, 20243335Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2024 Professional Claims
Apr 16, 20243334Attention Provider Type 19 (Nursing Facility): Provider-Specific Rates Updated
Apr 16, 20243333Attention Provider Types 19 (Nursing Facility) and 65 (Hospice, Long Term Care): Update Regarding Claims Impacted by State Fiscal Year 2024 Quarter 3 Rates
Apr 15, 20243332URGENT UPDATE: Electronic Medical Claim Submission Has Resumed Through Optum Change Healthcare (CHC) Network
Apr 15, 20243331Attention Provider Type 64 (Hospice): Claims Reprocessed in Order Received by Nevada Medicaid
Apr 15, 20243330Provider Type 55 (Day and Residential Habilitation Services) Claims Reprocessed
Apr 11, 20243329Provider Type 29 Home Health Agency and Private Duty Nursing Services Billing Guide Updated
Apr 05, 20243328Medicaid Services Manual Chapters Updated
Apr 04, 20243327Attention Providers of Ocular Procedure Codes: Provider Type (PT) 20 (Physician, M.D., Osteopath, D.O.), PT 24 (Advanced Practice Registered Nurse), PT 25 (Optometrist), PT 41 (Optician, Optical Business) and PT 77 (Physician’s Assistant)
Apr 04, 20243326Silver State Scripts Board (SSSB) Made Changes to Preferred Drug List (PDL) Effective April 4, 2024
Apr 03, 20243325Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2024 Professional Claims
Apr 02, 20243324Centralized Credentialing Process
Apr 02, 20243323Attention Provider Type 38 (Waiver for Individuals with Intellectual and Developmental Disabilities): Rate Updates Per Senate Bill (SB) 504
Apr 02, 20243322Attention Provider Type 38 (Waiver for Individuals with Intellectual and Developmental Disabilities): Limitation Changes Implemented
Apr 01, 20243321COVID-19 UNWIND: Claims for Some COVID-19 Administration and Vaccine Procedure Codes Have Been Reprocessed
Apr 01, 20243320Drug Use Review (DUR) Board Approves Changes Effective April 1, 2024
Mar 29, 20243319Attention Personal Care Services (PCS) and PCS-Like Services Providers: Claims Have Been Reprocessed to Pay Updated Rates
Mar 29, 2024Volume 21 Issue 1Nevada Medicaid and Nevada Check Up News (First Quarter 2024 Provider Newsletter)
Mar 27, 20243318Attention Provider Types (PTs) 12 (Hospital, Outpatient), 20 (Physician, M.D., Osteopath, D.O.) and 27 (Radiology and Non-invasive Diagnostic Centers): Radio-Pharmaceutical Code A9595 Open for Billing
Mar 26, 20243317Attention All Providers: Claims Denied With Error Code 4014 Have Been Reprocessed
Mar 26, 20243316Attention Provider Type 21 (Podiatrist): Rates Added for X-ray Exam Procedure Codes
Mar 22, 20243315Attention Applied Behavior Analysis Providers: Public Hearing Scheduled for March 26, 2024, on Proposed Changes to Medicaid Services Manual (MSM) Chapter 3700
Mar 22, 20243314Attention All Providers, Delegates and Staff: Upcoming Training Sessions for April 2024
Mar 20, 20243313URGENT NOTIFICATION Regarding Postponement of March 21, 2024, Personal Care Services Provider Listening Session
Mar 19, 20243312Attention Provider Type 33 (Durable Medical Equipment, Prosthetics, Orthotics and Supplies): Wearable Cardioverter Defibrillator (WCD) Vest Covered Effective January 1, 2024
Mar 19, 20243311Attention All Providers: Update Regarding Claims for Procedure Code H0004 Impacted by Limitation Error Codes 5690 and 5691 (Updated May 9, 2024)
Mar 18, 20243310Attention All Fee-For-Service Providers: Nevada’s Medicaid Managed Care to Expand to Rural Communities
Mar 15, 20243309URGENT NOTIFICATION: Claim Submission Options During Optum Change Healthcare (CHC) Network Service Outage
Mar 14, 20243308URGENT UPDATE: “Medicaid and CHIP Renewals: What to Know and How to Prepare” Webinar Rescheduled for March 20, 2024
Mar 14, 20243307Medicaid Services Manual Chapters Updated
Mar 13, 20243306Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines for 2024
Mar 13, 20243305Updates Regarding Telehealth for Behavioral Health Services
Mar 13, 20243304Medicaid Management Information System Updated with NCCI Quarter 1 2024 Files
Mar 12, 20243303Adult Day Health Care (ADHC) Professional and Professional Crossover Claims
Mar 12, 20243302Provider Type 85 (Applied Behavior Analysis) Claims Reprocessed
Mar 08, 20243301Attention Provider Types 30 (Personal Care Services - Provider Agency) and 83 (Personal Care Services - Intermediary Service Organization): Claims for Procedure Code T1019 Reprocessed
Mar 08, 20243300Attention Home and Community Based Waiver Providers for the Frail Elderly and for Persons with Physical Disabilities: Claims Reprocessed to Adjudicate With Updated Rates
Mar 08, 20243299URGENT NOTIFICATION for Personal Care Service Providers Regarding Electronic Visit Verification (EVV) Claims (Updated March 20, 2024)
Mar 06, 20243298Attention Provider Types 12 (Hospital, Outpatient) and 43 (Laboratory, Pathology Clinical): Biomarker Testing Procedure Codes Update (Updated May 8, 2024)
Mar 05, 20243297Indian Health Program Rates Adjusted for Calendar Year 2024
Mar 05, 20243296Attention Provider Type 38 (Waiver for Individuals with Intellectual and Developmental Disabilities): Error Code 5042 Updated
Mar 04, 20243295Attention Provider Type 22 (Dentist): Resources Regarding Human Papillomavirus (HPV) Vaccinations for Children
Mar 01, 20243294URGENT NOTIFICATION for Electronic Visit Verification (EVV) Providers: Temporary Claims Submission Option Now Available
Feb 29, 20243293Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2024 Professional Claims
Feb 29, 20243292Attention Provider Type 11 (Hospital, Inpatient): Claims for Newborn Admission Revenue Codes 170, 171 and 172 That Paid in Error Have Been Reprocessed
Feb 28, 20243291Claims for Vaccine Procedure Codes That Denied in Error Have Been Reprocessed
Feb 28, 20243290Updates to Coverage and Limitations for Obstetric Admissions and Elective/Non-Medically Necessary Cesarean Sections
Feb 27, 20243289Attention Provider Types 12 (Hospital, Outpatient) and 27 (Radiology and Non-invasive Diagnostic Centers): Electrophysiological Procedure Codes Opened for Billing
Feb 27, 20243288Rate Updates Implemented for Home and Community Based Waiver for the Frail Elderly Services
Feb 26, 20243287Attention Behavioral Health Outpatient and Rehabilitative Treatment Providers: Active Peer Recovery Support Specialist (PRSS) Certification Required for Nevada Medicaid Enrollment, Re-enrollment or Revalidation
Feb 23, 20243286Attention All Providers, Delegates and Staff: Upcoming Training Sessions for March 2024 (Updated February 28, 2024)
Feb 22, 20243285Attention Provider Type 19 (Nursing Facility): Clarification of Managed Care Organization Responsibility for the First 180 Days
Feb 22, 20243284Medicaid Services Manual Chapters Updated
Feb 21, 20243283Claims for Add-On Procedure Code 99417 (Prolonged Outpatient Evaluation and Management Service(s))
Feb 21, 20243282New Email Notification Added to Secure Correspondence Tool
Feb 16, 20243281Attention Provider Type 63 (Residential Treatment Center/Psychiatric Residential Treatment Facility): Initial Prior Authorization Requests for Youth
Feb 16, 20243280Attention All Providers: Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023
Feb 15, 20243279COVID-19 UNWIND: Attention All Providers and Community Partners: Free Medicaid Resources to Assist Recipients
Feb 15, 202432782024 Annual New Code Update
Feb 14, 20243277Enrollment Begins for Certified Community Behavioral Health Centers (CCBHCs) Statewide
Feb 07, 20243276Attention Provider Type 33 (Durable Medical Equipment, Prosthetics, Orthotics and Supplies): Catheter Procedure Codes Limitation
Feb 06, 20243275Attention Provider Type 29 (Home Health Agency and Private Duty Nursing Services): 15 Percent Rate Increase Effective January 1, 2024
Feb 05, 20243274Drug Use Review (DUR) Board Approves Changes Effective February 5, 2024
Feb 05, 20243273Updates Made to Prior Authorization Policy of Continuous Glucose Monitors (CGMs)
Feb 02, 20243272Attention All Providers: New Call Center Virtual Hold/Callback Option
Feb 01, 20243271Urgent Announcement: Professional Crossover Claims Reprocessing Effort Has Been Cancelled
Jan 30, 20243270Rate Increases for Personal Care Services (PCS) and PCS-Like Services (Updated February 12, 2024)
Jan 29, 20243269Professional and Professional Crossover Claims With Duplicate Details on History and Current Claims That Paid in Error Have Been Reprocessed
Jan 29, 20243268Outpatient and Professional Claims Billed With Modifier 51 Reprocessed
Jan 25, 20243267Prior Authorization Requirements for Laboratory Services Used for Biomarker Testing
Jan 25, 20243266Attention All Providers, Delegates and Staff: Upcoming Training Sessions for February 2024
Jan 23, 20243265Attention Marriage and Family Therapists (MFT) and Mental Health Counselors (MHC) Delivering Services to Dual Eligible Recipients and Behavioral Health Providers Delivering Intensive Outpatient Programs (IOP) to Dual Eligible Recipients
Jan 23, 20243264Attention Provider Types 19 (Nursing Facility) and 65 (Hospice, Long Term Care): State Fiscal Year 2024 Quarter 3 Rate Updates Implemented
Jan 23, 20243263Attention Provider Types 60 (School Health Services (SHS)) and 85 (Applied Behavior Analysis (ABA)): Rate Updates for Some Applied Behavior Analysis Services. (Updated February 5, 2024)
Jan 18, 20243262Recipient Eligibility for Postpartum Care Services
Jan 11, 20243261Crossover Claims That Had Negative Payment Amounts from Medicare Have Been Reprocessed
Jan 10, 20243260Attention Provider Types 10 (Outpatient Surgery, Hospital Based) and 46 (Ambulatory Surgical Centers): Anesthesia Procedure Codes 01937-01942 Cannot Be Billed
Jan 09, 20243259Claims for Mammography Procedure Codes 77063 and 77067 Submitted With Modifiers TC or 26 That Denied In Error Have Been Reprocessed
Jan 08, 20243258Attention Federally Qualified Health Centers (FQHC) Billing Encounter Codes Under Fee-For-Service (FFS) Medicaid
Jan 05, 20243257Attention Provider Type 20 (Physician, M.D., Osteopath, D.O.): Claims for Procedure Code 77063 With Modifier TC May Have Denied With Error Code 4014
Jan 05, 20243256Updates to Coverage and Limitations for Obstetric Admissions (Updated January 22, 2024)
Jan 05, 20243255Medicaid Services Manual Chapters Updated
Jan 03, 20243254Attention Provider Types 30 (Personal Care Services - Provider Agency) and 83 (Personal Care Services - Intermediary Service Organization): Authorization Request for Personal Care Services (PCS) Form FA-24 and Instructions Updated
Jan 03, 202432531099-Misc. Forms for 2023 Tax Year to be Mailed to Providers by January 31, 2024
Jan 02, 20243252Drug Use Review (DUR) Board Approves Changes for Physician Administered Drugs (PAD)
Jan 02, 20243251Drug Use Review (DUR) Board Approves Changes Effective January 2, 2024
Dec 28, 2023Volume 20 Issue 4COVID-19 UNWIND: Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2023 Provider Newsletter)
Dec 28, 20233250Silver State Scripts Board (SSSB) Made Changes to Preferred Drug List (PDL) Effective December 28, 2023
Dec 26, 20233249Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 2023 Professional Claims
Dec 21, 20233248COVID-19 UNWIND: Recipient Nevada Medicaid Disenrollments and Procedural Denials to Restart Effective January 1, 2024
Dec 21, 20233247URGENT ANNOUNCEMENT: Professional Crossover Claims Reprocessing Effort on Hold
Dec 20, 20233246Error Codes 5620, 5633 and 5681 Updated for Crossover Claim Types
Dec 20, 20233245Attention Behavioral Health Providers: Service Limitations for Outpatient Psychotherapy Reset January 1 of Each Year
Dec 20, 20233244False Claims Act Initial Certification or Recertification Letters (Updated January 16, 2024)
Dec 19, 20233243Attention Provider Type 64 (Hospice): Federal Fiscal Year (FFY) 2024 Annual Rates Update
Dec 18, 20233242Updated American Dental Association (ADA) Dental Claim Form to be Released January 1, 20