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
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

Return to Announcements / Training.