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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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

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 6 p.m. to midnight Pacific Time Sunday, May 19, 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)
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    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

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 March 2024 Professional Claims. See Web Announcement 3335.

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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51. E-Binder_SSSB_September_2021.pdf
... there were 2 cases of invasive ductal breast carcinoma, 1 case of renal-cell carcinoma ... Antiulcer Agents, H2 blockers; Proton Pump Inhibitors (PPIs); Functional Gastrointestinal ...
Terms matched: 2  -  Score: 410  -  16 Sep 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_September_2021.pdf
52. Immunomodulators_2021-10.pdf
... 1) . There was no evidence of statistically significant differences in the rates of breast cancer at 12 months, fever at 6 months, flu-like syndrome at 6 ...
Terms matched: 1  -  Score: 176  -  27 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2021-10.pdf
53. Antiemetics_2021-10.pdf
... RCT evaluated dexamethasone compared to aprepitant in the prophylaxis of delayed CINV in patients with breast cancer who received chemotherapy containing anthracyclines and cyclophosphamide and the same antiemetic prophylaxis regimen ...
Terms matched: 1  -  Score: 74  -  27 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Antiemetics_2021-10.pdf
54. Calcitonin_CGRP_Inhibitors_2021-10.pdf
... . Abbreviations: CrCL = creatinine clearance; CYP = cytochrome P450; BCRP = breast cancer resistance protein; IV = intravenous; ODT = orally disintegrating tablet; ...
Terms matched: 1  -  Score: 11  -  27 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Calcitonin_CGRP_Inhibitors_2021-10.pdf
55. Statins_2021-09.pdf
... adult patients. for other approved Use with Potential excretion indications have caution in into breast milk; not been severe renal contraindicated established. dysfunction; during doses above ...
Terms matched: 1  -  Score: 54  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Statins_2021-09.pdf
56. Immunomodulators_2021-09.pdf
... 1) . There was no evidence of statistically significant differences in the rates of breast cancer at 12 months, fever at 6 months, flu-like syndrome at 6 ...
Terms matched: 1  -  Score: 176  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2021-09.pdf
57. Pancreatic_Enzymes_2021-09.pdf
... lipase units/kg per meal by breast milk or (or â ‰ 10 ... be taken in combination with a proton pump inhibitor (PPI) . ï ‚ ...
Terms matched: 2  -  Score: 83  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pancreatic_Enzymes_2021-09.pdf
58. Multiple_Sclerosis_Agents_2021-09.pdf
... Among the ocrelizumab-treated patients that developed neoplasms, there were 2 cases of invasive ductal breast carcinoma, 1 case of renal-cell carcinoma, and 1 case of malignant melanoma ...
Terms matched: 1  -  Score: 76  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Multiple_Sclerosis_Agents_2021-09.pdf
59. Carbidopa_Levodopa_Agents_2021-09.pdf
... , a administered with the continuous dose, and extra doses CADD-Legacy 1400 portable infusion pump. At the end of the 16-hour infusion, patients will disconnect pump from ...
Terms matched: 1  -  Score: 24  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Carbidopa_Levodopa_Agents_2021-09.pdf
60. Insulin_and_Combination_Agents_2021-09.pdf
... a continuous infusion can be considered, with some recent data demonstrating modest advantages with pump therapy such as increased HbA1c lowering and reduced severe hypoglycemia rates. In addition ...
Terms matched: 1  -  Score: 23  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Insulin_and_Combination_Agents_2021-09.pdf
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