Nevada Medicaid and Nevada Check Up News (Second Quarter 2018 Provider Newsletter) [Read]

Behavioral Health Providers Invited to Attend Monthly DHCFP Webinars [See Web Announcement 1628]

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]


2018 Nevada Medicaid Conference Scheduled [See Web Announcement 1650]

Urgent: The issue causing the delay in the adjudication of claims for physician-administered drugs has been resolved. Claims submitted July 2, 2018, forward will adjudicate correctly. The adjudication of the pended claims will appear on remittance advices dated July 20, 2018, and/or July 27, 2018.

Status of Behavioral Health Outpatient Treatment Claims for Psychiatric Visits That Denied In Error [See Web Announcement 1647]

Preparations Continue for the Medicaid Management Information System Modernization Project – Trading Partner Enrollment and Certification (Testing) [See Web Announcement 1655]

Attention All Providers and Electronic Billing Trading Partners: Medicaid Management Information System Enhancements Will Improve Claims and Enrollment Processes. [See Web Announcement 1559]

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

8:00PM - 12:30AM

Notice Date Title
Aug. 6, 2018 Drug Use Review (DUR) Board Approves Changes Effective August 6, 2018
June 21, 2018 Pharmacy Announcement: Prior Authorization for High Dollar Claims will be Implemented August 6, 2018
June 20, 2018 Drug Use Review (DUR) Board Approves Changes Effective May 7, 2018
June 7, 2018 Hospira Issues Voluntary Nationwide Recall for Two Lots of Naloxone Hydrochloride Injection
May 7, 2018 Prior Authorization Required for Mavyret™ and Vosevi®
Feb. 2, 2018 Drug Use Review (DUR) Board Approves Change Effective February 5, 2018
Jan. 2, 2018 Medicare Part-D Co-Pay Change
Dec. 29, 2017 Drug Use Review (DUR) Board Approves Changes Effective January 1, 2018
Dec. 22, 2017 Coverage Requirements for Contraceptive Drugs, Devices and Services to Implement on January 1, 2018
Oct. 6, 2017 Respiratory Syncytial Virus (RSV) Prophylaxis with Synagis® (Palivizumab)
Oct. 6, 2017 Insulin Quantity Limit Adjusted to Allow 65 to 120 Day Supply
Oct. 2, 2017 Legislative Assembly Bill AB473 Extends NRS 422.4025 Sunset until June 30, 2019
July 31, 2017 Drug Use Review (DUR) Board Approves Changes Effective August 1, 2017
May 5, 2017 Criteria for Practitioners to Dispense Medications
May 2, 2017 Drug Use Review (DUR) Board Approves Changes to MSM Chapter 1200
May 1, 2017 Quantity Limits Approved at January 2017 Drug Use Review Board Meeting
March 30, 2017 Opioid Therapeutic Class to be Added to Medicaid Services Manual (MSM) Chapter 1200 (Prescribed Drugs) (Updated April 28, 2017)
Feb. 23, 2017 Attention Prescribers and Pharmacies: Mandatory Three-Month Supplies for Maintenance Medications
Feb. 10, 2017 Pharmacy Announcement: Bypass Function Added for Claims for Children under Age 18 with a Diagnosis Related to a Seizure Disorder when Prescriber is a Neurologist (Updated March 24, 2017)
Dec. 30, 2016 Pharmacy Co-Pay Increase for Brand Name Medications for Dual-Eligible Medicare Recipients
Dec. 30, 2016 Pharmacy Announcement Regarding Claims for Snake Anti-Venom
Dec. 30, 2016 Quantity Limit for Birth Control Pills
Dec. 22, 2016 Attention Pharmacies: Emergency Supply Policy
Nov. 7, 2016 Drug Use Review Board (DUR) Approves Changes to MSM Chapter 1200 Effective November 9, 2016
Nov. 4, 2016 Pharmacy Benefit Manager Changes from CatamaranRx to OptumRx
Nov. 3, 2016 Nevada Medicaid Informational Bulletin on Medications and Services for Substance Use Disorders
Oct. 14, 2016 Drug Quantity Limits Effective October 17, 2016
Sept. 12, 2016 Instructions for Claims for Gender Identity Disorder Hormones
June 3, 2016 Drug Quantity Limits Effective May 16, 2016
May 20, 2016 New Prior Authorization Forms Available for Psychotropic Agents
May 4, 2016 Nevada Medicaid Will Use Federal Upper Limit Pricing Provided by Centers for Medicare & Medicaid Services for Outpatient Drugs
April 27, 2016 June 2016 Pharmacy and Therapeutics (P&T) Committee Meeting Canceled
April 1, 2016 Update Regarding Psychotropic Medications for Children and Adolescents (Updated May 3, 2016)
March 1, 2016 Reminder to Pharmacy Providers: Document Counseling when Dispensing a Medication
Feb. 12, 2016 Narcan Nasal Spray Added to Preferred Drug List
Dec. 18, 2015 Quantity Limits for Sedative/Hypnotic Agents (Updated January 22, 2016)
Dec. 15, 2015 Psychotropic Medications for Children and Adolescents
Nov. 18, 2015 Urgent Pharmacy Announcement: Pricing Override Allowing Brand Products to Pay at Brand Price
Oct. 27, 2015 ICD-10 Diagnosis Code Reference for Drug Claims
Oct. 12, 2015 Open Provider Forums Scheduled Regarding: Pharmacy Dispensing Fee Increase and Pricing Methodology Using National Average Drug Acquisition Cost (NADAC) Files
Oct. 7, 2015 Future Changes to MSM Chapter 1200, Prescribed Drugs
Sept. 23, 2015 Pharmacy Dispensing Fee Increase and Pricing Methodology Using National Average Drug Acquisition Cost (NADAC) Files
Aug. 24, 2015 Naloxone to be Listed as Preferred on Preferred Drug List
Aug. 18, 2015 Pharmacy Dispensing Fee Increase and Pricing Methodology Using National Average Acquisition Cost (NADAC) Files
July 27, 2015 Quantity Limits for Hepatitis C Treatment Agents
July 21, 2015 Viekira Pak® Notification
July 1, 2015 Drug Use Review (DUR) Board Approves Changes to MSM Chapter 1200 Effective July 1, 2015
June 25, 2015 State Maximum Allowable Cost (MAC) Applied to Abilify® (Updated July 13, 2015)
April 8, 2015 Claims for Lexiscan® to be Reprocessed
April 3, 2015 Physician-Administered Drug Claims Reprocessed
March 24, 2015 Pharmacy Claims Payments to be Delayed One Week
March 13, 2015 Changes for Pharmacies and Prescribers of Psychotropic Medications for Children and Adolescents Have Been Removed from the Prior Authorization Form (Updated May 1, 2015)
Feb. 19, 2015 Duplicate Dispensing Fees on Claims for Long Term Care Pharmacy Dispensing IV Medications
Feb. 18, 2015 Drug Use Review (DUR) Board Approves Changes to MSM Chapter 1200 Effective January 1, 2015
Feb. 6, 2015 Attention Pharmacies: New Billing Instructions for Vaccine Claims when Submitted with a Non-participating Prescriber Due to Ordering, Prescribing and Referring (OPR) Practitioner Validation
Dec. 22, 2014 Physician-Administered Drug Claims that Denied with Edit Code 9051 (Prescriber is not Covered) in Error will be Reprocessed
Nov. 12, 2014 Use of Pharmacy Drug Discount Cards by Recipients and Retro-Eligible Refunds
Oct. 30, 2014 Quantity Limit for Oral Contraceptives
Oct. 29, 2014 Update for Pharmacies: Override Period for Point-of-Sale Processing for Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners Ends February 5, 2015 (Updated December 9, 2014, and January 9, 2015)
Oct. 28, 2014 Vaccines Administered by Pharmacies
Oct. 13, 2014 Copaxone® 20 mg Billing Update
Sept. 29, 2014 Hydrocodone Combination Products Change to DEA Schedule 2
Aug. 29, 2014 Attention Pharmacies: Update Regarding Implementation of Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners
Aug. 25, 2014 Drug Use Review (DUR) Board Approves Quantity Limits Effective September 9, 2014
July 16, 2014 Drug Use Review (DUR) Board Makes Changes to MSM Chapter 1200 Effective July 1, 2014
July 14, 2014 340B Drug Discount Program
June 12, 2014 Physician-Administered Drug Claim Rejections
June 10, 2014 Brand Name Medications on PDL Pay at “Lesser-of Logic” Pricing (Updated June 24, 2014)
June 2, 2014 Physician-Administered Drug Claims That Reimbursed with Dispensing Fees Will Be Reprocessed
May 29, 2014 Payment Delay for Claims for Newly Eligible/Childless Adults
Mar. 26, 2014 Quantity Limit for Promethazine with Codeine Cough Syrup
Feb. 19, 2014 Attention Pharmacies: Claims adjudication process to validate ordering, prescribing and referring (OPR) practitioners
Feb. 12, 2014 Prescription Co-pay Increases for Dual-eligible Recipients
Feb. 4, 2014 Billing Instruction for Benzodiazepines and Barbiturates for Dual-Eligible Recipients
Jan. 8, 2014 Thyrogen® Payable to Physicians for Pharmacy Therapy
Jan. 7, 2014 Policy Reminders for Covered and Non-covered Medication Process for Hospice Recipients
Oct. 24, 2013 Physician Claims for Partial Quantities of Certain Drugs Have Been Reprocessed
Oct. 18, 2013 Clinical Prior Authorization Required for Prolia®, Forteo®, Cesamet®, Marinol® and Omontys®
Sept. 20, 2013 Name(s) of Failed Products Must Be Documented on Prior Authorization Forms
Aug. 21, 2013 Lexiscan® Billing Notification
Aug. 16, 2013 Ritalin LA® Reimbursed at Available Wholesale Acquisition Cost (WAC)
Aug. 9, 2013 Actual Acquisition Cost (AAC) for Pharmacy Products That Do Not Have Other Pricing on File
July 17, 2013 Recipient's Date of Birth to be Required on Pharmacy Claims
July 16, 2013 CPT Code 90686 (Fluarix®) is FDA-Approved and is a Vaccine for Children (VFC) Vaccine
July 16, 2013 Vaccine/Immunization Information for Pharmacies
July 1, 2013 Requirements for Over the Counter (OTC) Medications
June 6, 2013 Generic Rizatriptan and Rizatriptan MLT Added to Preferred Drug List
June 6, 2013 Drug Use Review Board Notification for Changes Effective May 16, 2013
May 14, 2013 Progesterone Reimbursement Notification
May 10, 2013 Attention Provider Types 20, 24, 28 and 77: Prior Authorization Reminder for Psychotropic Drugs
Apr. 26, 2013 Avastin® Notification
Feb. 13, 2013 Paclitaxel IV Quantity Limits Notification
Feb. 13, 2013 Suboxone® Notification
Jan. 23, 2013 Concerta® Announcement for Provider Types 14, 17, 20, 21, 22, 24, 25, 27, 28, 31, 36, 37, 45, 72, 76
Jan. 21, 2013 Solu-Cortef® Point of Sale Notification
Jan. 4, 2013 Reimbursement for Secondary Claims for Medicare Part B Covered Drugs
Dec. 12, 2012 Geodon® Point of Sale Notification
Dec. 12, 2012 Seroquel® Point of Sale Notification
Dec. 10, 2012 Quantities of Partial Units of Measure on Drug Claims Effective December 10, 2012
Oct. 5, 2012 Generic Form of Singular® Added to PDL
Oct. 5, 2012 Updated Payment Algorithm for Brand Name Medications
Oct. 4, 2012 Quantity Limit for Herceptin®
June 6, 2012 DUR Board Approves Changes to MSM Chapter 1200 Effective April 17, 2012
May 2, 2012 Pharmacist-Administered Adult and Childhood Immunizations Covered by Nevada Medicaid and Nevada Check Up
Apr. 25, 2012 FDA Acetaminophen Dosage Announcement
Mar. 23, 2012 Pharmacy Provider Training and Open Forum on March 27, 2012
Mar. 15, 2012 EDI Announcement: March 31, 2012, End Date for Dual Use of NCPDP 5.1/D.0 and Extension of Dual Use for 4010/5010 Formats until June 30, 2012
Feb. 2, 2012 NCPDP D.0 Payer Sheet for Pharmacy Providers
Dec. 16, 2011 EDI Announcement: Nevada Medicaid Dual Use for 5010 and D.0 Formats
Dec. 14, 2011 NCPDP D.0 Testing Instructions (Updated Dec. 16, 2011)
Oct. 14, 2011 AWP Benchmark Replaced by WAC
Oct. 05, 2011 DUR Board Changes Effective Aug 25, 2011
Oct. 04, 2011 Nevada Medicaid Removes Carisoprodol from PDL
Sep. 22, 2011 Nevada Medicaid Covers Hydroxyprogesterone Caproate
Jul. 18, 2011 Preferred Drug List (PDL) Changes (Effective September 29, 2011) (Previously effective August 30, 2011 and Sept 15, 2011)
Feb. 25, 2011 Reminder: Prevnar 13® is a Vaccine for Children (VFC) Vaccine
Feb. 8, 2011 Preferred Drug List (PDL) Changes Effective March 9, 2011
Jan. 19, 2011 Prior Authorization Required for Synagis® During RSV Season
Previous Years’ Announcements
Notice Date Title
2010 All 2010 Pharmacy Announcements
2009 All 2009 Pharmacy Announcements
2008 All 2008 Pharmacy Announcements
2007 All 2007 Pharmacy Announcements
2006 All 2006 Pharmacy Announcements
2005 All 2005 Pharmacy Announcements

Nevada Medicaid offers comprehensive provider training free of charge. We encourage the attendance of health care providers, direct practitioners, billing staff, billing agencies, office managers, admitting or front-desk staff, utilization review staff, case management staff, etc.

Form Number Title
FA-43 No Pharmacy provider training scheduled at this time