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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61. NV_Billing_General_online_2010-05-28_to_2010-06-14.pdf
... Medicaid Card .... 14 Fee For Service vs. Managed Care .... 14 MCO Contact Information .... 15 Chapter 4: Prior and Retrospective Authorization .... ...
Terms matched: 1  -  Score: 303  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2010-05-28_to_2010-06-14.pdf
62. NV_Billing_General_online_2010-06-14_to_2011-06-20.pdf
... Medicaid Card .... 14 Fee For Service vs. Managed Care .... 14 MCO Contact Information .... 15 Chapter 4: Prior and Retrospective Authorization .... ...
Terms matched: 1  -  Score: 303  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2010-06-14_to_2011-06-20.pdf
63. NV_Medicaid_News_2016-0930.pdf
... series of breakout sessions. Providers can choose from Medicaid the following breakout sessions when ... both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. ï ‚ You ...
Terms matched: 2  -  Score: 303  -  29 May 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2016-0930.pdf
64. DHCFP_EVV_Selection_Form.pdf
... _ EVV VENDOR SYSTEM SELECTIONS: (Choose only one EVV vendor system to be ... through a Medicaid Managed Care Organization (MCO) . (effective date: ___ ...
Terms matched: 2  -  Score: 303  -  21 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DHCFP_EVV_Selection_Form.pdf
65. NV_Billing_General_20110620.pdf
... Medicaid Card .... 14 Fee For Service vs. Managed Care .... 14 MCO Contact Information .... 15 Chapter 4: Prior and Retrospective Authorization .... ...
Terms matched: 1  -  Score: 303  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20110620.pdf
66. Binder_DUR_2017-1011.pdf
... such patients in deciding which glucocorticoid to choose, when to initiate treatment, and ... ™s has been conducted. The MCO expansion was effective July 1, 2017 ...
Terms matched: 2  -  Score: 303  -  29 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2017-1011.pdf
67. NV_Billing_General_online_2009-01-30_to_2009-03-10.pdf
... Eligibility ... 15 Sample Medicaid Card... 15 Fee For Service vs. Managed Care... 15 MCO Contact Information... 16 AMERIGROUP Community Care ... 16 Health Plan of Nevada (HPN ...
Terms matched: 1  -  Score: 303  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2009-01-30_to_2009-03-10.pdf
68. web_announcement_Volume 17, Issue 1_20200416.pdf
... some of the published web announcements: Choose Service Location Web Announcement 2137: Pharmacy ... Organization and Resolutions and/or (MCO) websites. The Providers section includes ...
Terms matched: 2  -  Score: 299  -  16 Apr 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2017,%20Issue%201_20200416.pdf
69. web_announcement_Volume 18 Issue 4_20211230.pdf
... Up News Volume 18, Issue 4 New Managed Care Organization Fourth Quarter 2021 (MCO) Contract and Caseload Inside Redistribution Effective January 1, 2022 This Issue: ...
Terms matched: 1  -  Score: 296  -  30 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2018%20Issue%204_20211230.pdf
70. web_announcement_Volume_2018_20Issue_204_20211230.pdf
... Up News Volume 18, Issue 4 New Managed Care Organization Fourth Quarter 2021 (MCO) Contract and Caseload Inside Redistribution Effective January 1, 2022 This Issue: ...
Terms matched: 1  -  Score: 296  -  03 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume_2018_20Issue_204_20211230.pdf
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