DUR Board
Announcements
Upcoming Meetings
January 23, 2020
April 30, 2020
July 23, 2020
October 29, 2020
DUR Clinical Criteria for Review
Meeting agendas are on the DHCFP’s Public Notices webpage.
Nevada Department of
Health and Human Services
Division of Health Care Financing and Policy Provider Portal
Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2019 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
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 December 2019 Claims. See Web Announcement 2073.
Top Prior Authorization Denial Reasons for the Fourth Quarter of 2019. See Web Announcement 2072.
Top 10 Enrollment Return Reasons and Resolutions for November and December 2019 Submissions. See Web Announcement 2071.
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.
Provider Links
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