Nevada Medicaid and Nevada Check Up News (Second 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

The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, August 7, 2022, for scheduled maintenance:

  • Secure Provider Web Portal (Electronic Verification System – EVS)
  • Online Provider Enrollment (OPE)
  • Online Provider Claim Appeals
  • Online Prior Authorization (PA) system
  • Online Claims Submission
  • Audio 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)

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 March 2021 Claims. Web Announcement 2472.

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

This page contains archived Pharmacy information for Preferred Drug List, DUR Board meetings, and Sliver State Scripts Board meeting materials. For current information visit https://nevadamedicaid.magellanrx.com/home.

Announcements

Upcoming Meetings

2022:

January 27, 2022

April 28, 2022

July 28, 2022

October 20, 2022


2023:

January 19, 2023

April 20, 2023

July 20, 2023

October 19, 2023


DUR Meeting Binder

DUR Clinical Criteria for Review

DUR Past Meeting Material

DUR Board Member List


Announcements

The Silver State Scripts Board consists of members who are Director-appointed physicians and pharmacists. Members must be licensed to practice in the State of Nevada as either an actively practicing physician or an actively practicing pharmacist.


Meetings are held quarterly and are open to the public. Anyone wishing to address the Silver State Scripts Board may do so. Public comment is limited to three minutes per speaker/organization (due to time constraints). Anyone presenting documents for consideration must provide sufficient copies for each Board Member and an electronic copy to the DHCFP Coordinator for official record.


For pharmacists and physicians wishing to serve on the Silver State Scripts Board, please email your contact information, National Provider Identifier (NPI) and current CV/Resume to rxinfo@dhcfp.nv.gov.


Upcoming Meetings

2022:

March 24, 2022

June 23, 2022

September 22, 2022

December 15, 2022


2023:

March 23, 2023

June 22, 2023

September 28, 2023

December 14, 2023


Silver State Scripts Board Meeting Binder

Silver State Scripts Board Clinical Meeting Information

Silver State Scripts Board Member List

P&T Past Meeting Material


Meeting agendas are on the DHCFP’s Public Notices webpage.

Notice Date Title
2022 All 2022 Pharmacy Preferred Drug List
2021 All 2021 Pharmacy Preferred Drug List
2020 All 2020 Pharmacy Preferred Drug List
2019 All 2019 Pharmacy Preferred Drug List
2018 All 2018 Pharmacy Preferred Drug List
2017 All 2017 Pharmacy Preferred Drug List
2016 All 2016 Pharmacy Preferred Drug List
2015 All 2015 Pharmacy Preferred Drug List
2014 All 2014 Pharmacy Preferred Drug List
2013 All 2013 Pharmacy Preferred Drug List
2012 All 2012 Pharmacy Preferred Drug List
2011 All 2011 Pharmacy Preferred Drug List
2010 All 2010 Pharmacy Preferred Drug List
2009 All 2009 Pharmacy Preferred Drug List
2008 All 2008 Pharmacy Preferred Drug List
PDL Forms

Pharmacy forms are for completion and submission by current Medicaid providers only.

Form Number Title
FA-62 Request for Pharmaceutical Product Review
FA-63 PDL Exception Prior Authorization Form
PDL Notifications
Notice Date Title
2022 All 2022 PDL Notifications
2021 All 2021 PDL Notifications
2020 All 2020 PDL Notifications
2019 All 2019 PDL Notifications
2018 All 2018 PDL Notifications
2017 All 2017 PDL Notifications
2016 All 2016 PDL Notifications
2015 All 2015 PDL Notifications
2014 All 2014 PDL Notifications
2013 All 2013 PDL Notifications
2012 All 2012 PDL Notifications
2011 All 2011 PDL Notifications
2010 All 2010 PDL Notifications
2009 All 2009 PDL Notifications
2008 All 2008 PDL Notifications
2007 All 2007 PDL Notifications
2006 All 2006 PDL Notifications
2005 All 2005 PDL Notifications
2004 All 2004 PDL Notifications
2003 All 2003 PDL Notifications