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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201. NV_BillingGuidelines_PT55_20210315.pdf
... provider. Note: PT 55 procedure codes are carved out of Managed Care (MCO) and services are paid out of FFS. (T2020 and T2017, ...
Terms matched: 1  -  Score: 20  -  12 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT55_20210315.pdf
202. Health_Plan_of_Nevada_DUR_Binder_April_2021.pdf
... Drug Use Review Board Meeting APRIL 22, 2021 2021 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 94  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_April_2021.pdf
203. Anthem_DUR_Binder_April_2021.pdf
... Presentation Presented to NV DUR Board on April 22, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 103  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2021.pdf
204. SilverSummit_DUR_Binder_April_2021.pdf
... Reports â€" 32 Multiple Sclerosis Agents Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 100  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_April_2021.pdf
205. web_announcement_2463_20210331.pdf
... - Service (FFS) recipients and those participating in a Managed Care Organization (MCO) . Providers/prescribers must submit all PA requests to OptumRx for review ...
Terms matched: 1  -  Score: 38  -  31 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2463_20210331.pdf
206. FFS_DUR_Binder_April_2021.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 66  -  26 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_April_2021.pdf
207. NV_BillingGuidelines_PT55.pdf
... provider. Note: PT 55 procedure codes are carved out of Managed Care (MCO) and services are paid out of FFS. (T2020 and T2017, ...
Terms matched: 1  -  Score: 20  -  23 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT55.pdf
208. NV_BillingGuidelines_PT55_20200518.pdf
... provider. Note: PT 55 procedure codes are carved out of Managed Care (MCO) and services are paid out of FFS. (T2020 and T2017, ...
Terms matched: 1  -  Score: 20  -  15 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT55_20200518.pdf
209. Multiple_Sclerosis_Agents_2021-04.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 23  -  05 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Multiple_Sclerosis_Agents_2021-04.pdf
210. Platelet_Aggregation_2021-04.pdf
... patients at increased risk of stroke and have undergone PCI, it is reasonable to choose Plavix over Effient. Double therapy with a P2Y 12 inhibitor (Plavix or ...
Terms matched: 1  -  Score: 22  -  05 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet_Aggregation_2021-04.pdf
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