Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2023 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

Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Please be advised that claims must be submitted before noon Pacific Time on Fridays to be included in the following weeks’ remittance advice.

Attention Electronic Visit Verification (EVV) providers: Claim invoices that were submitted through Sandata Thursday, March 14, 2024, through Tuesday, March 19, 2024, were not being received in the Medicaid Management Information System (MMIS). The impacted files have been received and are being processed. Claim adjudication details will appear on remittance advices dated March 29, 2024.

URGENT NOTIFICATION: Physician Administered Drug (PAD) claims may be experiencing a host eligibility error. The impacted claims will be reprocessed automatically. No action is needed by providers.

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

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 January 2024 Professional Claims. See Web Announcement 3293.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023. See Web Announcement 3280.

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

The Nevada Division of Health Care Financing and Policy (DHCFP) has selected a new fiscal agent, Nevada Medicaid. The following documents contain information regarding the fiscal agent transition.

Notice Date Topic Document Source
Dec. 6, 2011 Provider FAQs: General Prior Authorization Information for all Providers with extra details regarding PASRR/LOC and Behavioral Health Requests Hewlett Packard
Dec. 1, 2011 Claims, Transactions and other Communications in Pending Status during Fiscal Agent Transition will Migrate to HPES Hewlett Packard
Nov. 30, 2011 Provider FAQs: General Transition, Provider Web Portal, Registration and Remittance Advices Hewlett Packard
Nov. 30, 2011 Provider FAQs: Pharmacy Prior Authorization Requests through the Fiscal Agent Transition Hewlett Packard
Nov. 28, 2011 Beginning December 2, 2011, SXC will process Nevada Medicaid and Nevada Check Up Pharmacy Claims Hewlett Packard
Nov. 22, 2011 HPES Schedules December Provider Training (Updated) Hewlett Packard
Nov. 22, 2011 HPES Transition and TPL FAQs Hewlett Packard
Nov. 22, 2011 Urgent: Register Early for Access to the Provider Web Portal Hewlett Packard
Nov. 21, 2011 NCPDP Version 5.1 Payer Sheet Hewlett Packard
Nov. 18, 2011 HPES Transition FAQs Update Hewlett Packard
Nov. 18, 2011 Recipient Identification (ID) Cards (FAQ Contains Updated Information for Providers) Hewlett Packard
Nov. 11, 2011 NCPDP D.0 Payer Sheet for Pharmacy Providers Hewlett Packard
Nov. 9, 2011 Claims Processing Transition Timeline Magellan Medicaid Administration
Nov. 8, 2011 Introduction to HPES Provider Web Portal Hewlett Packard
Nov. 8, 2011 TPL Deliveries after December 2, 2011 Hewlett Packard
Nov. 7, 2011 HPES Transition FAQs for Prior Authorzation (PA) and Preadmission Screening and Resident Review (PASRR) Hewlett Packard
Nov. 4, 2011 EDI Testing Opportunities for 5010 and D.0 Formats Hewlett Packard
Nov. 3, 2011 HPES Transition FAQs for Pharmacy Providers Hewlett Packard
Oct. 17, 2011 HPES Transition FAQs Hewlett Packard
Oct. 11, 2011 Update Regarding November Provider Training (Web Announcement 420) Magellan Medicaid Administration
Oct. 10, 2011 Medicaid Fiscal Agent Transition Webpage (Web Announcement 419) Magellan Medicaid Administration
Oct. 10, 2011 Third Quarter 2011 Newsletter Magellan Medicaid Administration
Oct. 7, 2011 Provider Training - November 2011 Hewlett Packard
Oct. 3, 2011 Oct. 7 is Final Day to Request a PIN to Register to Use Magellan Medicaid Administration’s EVS, OPAS and Pharmacy Web PA (Web Announcement 416) Magellan Medicaid Administration
Sept. 21, 2011 HP to present at Nevada Medicaid Conference Hewlett Packard
July 26, 2011 Register Now for the Free Annual Medicaid Conference Scheduled in October (Web Announcement 413) Magellan Medicaid Administration
July 22, 2011 Second Quarter 2011 Newsletter Magellan Medicaid Administration