Nevada Medicaid and Nevada Check Up News (First 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, May 22, 2022, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS)
  • Online Provider Enrollment (OPE)
  • Online Prior Authorization (PA) system
  • Online Claims Submission
  • Online Provider Claim Appeals
  • Audio Response System (ARS) (800-942-6511)
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR


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

Notice Date Title
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

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