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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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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31. NV_BillingGuidelines_PT54__20100628.pdf
... A recipient diagnosed with SED or SMI chooses to disenroll from the TCM services do ... in areas where Managed Care Organization (MCO) enrollment is mandatory may disenroll from ...
Terms matched: 2  -  Score: 365  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54__20100628.pdf
32. NV_BillingGuidelines_PT54_20100513.pdf
... A recipient diagnosed with SED or SMI chooses to disenroll from the TCM services do ... in areas where Managed Care Organization (MCO) enrollment is mandatory, may disenroll ...
Terms matched: 2  -  Score: 365  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20100513.pdf
33. NV_BillingGuidelines_PT54.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. If ... disenroll from the Managed Care Organization (MCO) based on an SMI determination. ...
Terms matched: 2  -  Score: 363  -  17 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54.pdf
34. NV_BillingGuidelines_PT54_20111205.pdf
... A recipient diagnosed with SED or SMI chooses to disenroll from the MCO. ( ... in areas where Managed Care Organization (MCO) enrollment is mandatory may disenroll from ...
Terms matched: 2  -  Score: 363  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20111205.pdf
35. web_announcement_272_20090708.pdf
... enrollment period during which period they may choose to change their health plan. Recipients ... Web Announcement 272 Managed Care Organization (MCO) Changes: 12-Month Recipient Lock-In Policy ...
Terms matched: 2  -  Score: 347  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_272_20090708.pdf
36. newsletter_v6i2.pdf
... the recipie nt’s health choose to change their health plan. care ... CONTENTS: Home Safety Message Page 2 MCO Lock-in Policy Page 3 Clinical Claim Editor ...
Terms matched: 2  -  Score: 346  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v6i2.pdf
37. PT_63_RTC_Training_2020.pdf
... denied or fewer days. If you choose to request fewer days than were originally ... member of a Managed Care Organization (MCO) . - The QIO-like vendor will ...
Terms matched: 2  -  Score: 343  -  04 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_63_RTC_Training_2020.pdf
38. PCS_Provider_Training_042418.pdf
... Delegate Assignment, continued †' Choose the Functions you want the delegate to ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for-Service (FFS): ...
Terms matched: 2  -  Score: 343  -  24 Apr 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PCS_Provider_Training_042418.pdf
39. web_announcement_1417_20170728.pdf
... period, recipients will be able to choose from one of the three MCOs: ... Aetna Better Health Managed Care Organization (MCO) has decided to terminate its contract ...
Terms matched: 2  -  Score: 340  -  28 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1417_20170728.pdf
40. FFS_DUR_Binder_July_2020.pdf
... RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. ... Carl has presented based off the other MCO recommendations? Dave England: This is ...
Terms matched: 2  -  Score: 337  -  16 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_July_2020.pdf
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