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. 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

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