Nevada Medicaid and Nevada Check Up News (First Quarter 2024 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]

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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 10 p.m. to midnight Pacific Time Saturday, June 29, 2024, for scheduled maintenance:
  • Real time CAQH/CORE EDI eligibility and claim verification

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, June 30, 2024, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR

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.

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 May 2024 Professional Claims. See Web Announcement 3382.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

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

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.

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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

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11. web_announcement_3310_20240318.pdf
... doctors and medical providers About 75,000 Medicaid members in rural Consider joining an MCO network. MCOs will Nevada will be enrolled in an MCO. About be ...
Terms matched: 1  -  Score: 37  -  18 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3310_20240318.pdf
12. NV_EnrollmentChecklist_PT85_specialty_885.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing; 7. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  18 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT85_specialty_885.pdf
13. NV_BillingGuidelines_PT11_online_010423.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  14 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_010423.pdf
14. NV_BillingGuidelines_PT11.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  14 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
15. NV_BillingGuidelines_PT75.pdf
... Fee-For-Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  14 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75.pdf
16. NV_BillingGuidelines_PT75_online_121619.pdf
... Fee-For-Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  14 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_121619.pdf
17. NV_Billing_General.pdf
... 2023 32 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 195  -  13 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
18. NV_Billing_General_20231130.pdf
... 2023 32 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 195  -  13 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20231130.pdf
19. web_announcement_3294_20240301.pdf
... : This temporary solution does not apply to Managed Care Organization payers or providers who choose to use an alternative EVV system. Temporary claims submission: The good news ...
Terms matched: 1  -  Score: 21  -  01 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3294_20240301.pdf
20. web_announcement_3285_20240222.pdf
... coverage period. Rather, at any time during the 180-day coverage period, an MCO may assess whether a recipient can be discharged to a lower level of care ...
Terms matched: 1  -  Score: 36  -  22 Feb 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3285_20240222.pdf
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