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]

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AuthentiCare® Nevada

Authorization Criteria

DHCFP Home

EDI Information

EVS User Manual

Modernization Project

Online Provider Enrollment

Provider Login (EVS)

Prior Authorization

Search Fee Schedule

Search Providers

Claims

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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

AuthentiCare® Nevada

Billing Information

E-Prescribing

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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

Pharmacy Prescriber List

The Centers for Medicare & Medicaid Services (CMS) has made available National Plan and Provider Enumeration System (NPPES) health care provider data via the internet. User IDs and passwords are not required and access to the data is free.


The NPI Registry and the NPPES Downloadable File are tools Nevada Medicaid pharmacy providers may use to obtain a physician’s National Provider Identifier (NPI) when entering the prescriber’s ID on claims.


The NPI Registry and the NPPES Downloadable File are accessible via the following links: