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.

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

Month Title
January 2020 For Review at January 23, 2020 Meeting: Antiasthmatic – Monoclonal Antibodies
January 2020 For Review at January 23, 2020 Meeting: Anticonvulsants
January 2020 For Review at January 23, 2020 Meeting: Irritable Bowel Syndrome and Constipation Agents
January 2020 For Review at January 23, 2020 Meeting: Multiple Sclerosis Agents
January 2020 For Review at January 23, 2020 Meeting: Narcolepsy Agents
October 2019 For Review at October 17, 2019 Meeting: Anti-inflammatory Agents – Misc., Topical
October 2019 For Review at October 17, 2019 Meeting: Enzyme Preparations and Wound Healing Products
October 2019 For Review at October 17, 2019 Meeting: Erythropoiesis Stimulating Agents
October 2019 For Review at October 17, 2019 Meeting: Narcolepsy Agents
October 2019 For Review at October 17, 2019 Meeting: Neuropathic Pain and Fibromyalgia Agents
October 2019 For Review at October 17, 2019 Meeting: Phosphodiesterase-4 Inhibitor for COPD
October 2019 For Review at October 17, 2019 Meeting: Respiratory Anticholinergics
October 2019 For Review at October 17, 2019 Meeting: Scabicides and Pediculicides
October 2019 For Review at October 17, 2019 Meeting: Zolgensma®
July 2019 For Review at July 25, 2019 Meeting: Anti-Migraine Agents (Triptans)
July 2019 For Review at July 25, 2019 Meeting: Growth Hormone
July 2019 For Review at July 25, 2019 Meeting: Irritable Bowel Syndrome and Constipation Agents
July 2019 For Review at July 25, 2019 Meeting: Spravato® (Esketamine)
April 2019 For Review at April 25, 2019 Meeting: Androgens
April 2019 For Review at April 25, 2019 Meeting: Attention-Deficit/Hyperactivity Disorder (ADHD) Agents
April 2019 For Review at April 25, 2019 Meeting: Fentanyl Immediate Release Products
April 2019 For Review at April 25, 2019 Meeting: Opioid Use Disorder Agents
April 2019 For Review at April 25, 2019 Meeting: Opioids, Long Acting
January 2019 For Review at January 24, 2019 Meeting: Angiotensin II Receptor Blockers (ARBs)
January 2019 For Review at January 24, 2019 Meeting: Anticonvulsants
January 2019 For Review at January 24, 2019 Meeting: Antivirals, Influenza
January 2019 For Review at January 24, 2019 Meeting: Inhaled Beta-Agonists
January 2019 For Review at January 24, 2019 Meeting: Oncology
January 2019 For Review at January 24, 2019 Meeting: Pulmonary Arterial Hypertension Agents