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)
  • 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
  • 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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61. Gout_2021-09.pdf
... only to authorized recipients. â — ‹ Monotherapy with an NSAID (with proton pump inhibitor where indicated), corticosteroids, or colchicine is recommended as first-line agents ...
Terms matched: 1  -  Score: 11  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Gout_2021-09.pdf
62. Calcitonin_Gene_2021-09.pdf
... . Abbreviations: CrCL = creatinine clearance; CYP = cytochrome P450; BCRP = breast cancer resistance protein; IV = intravenous; ODT = orally disintegrating tablet; ...
Terms matched: 1  -  Score: 11  -  09 Aug 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Calcitonin_Gene_2021-09.pdf
63. FFS_DUR_Binder_July_2021.pdf
... ‚ Avoid concomitant use with P-glycoprotein and breast cancer resistant protein substrates. DOSING AND ... 1 spray in be primed with 4 pumps. Migranal each nostril; 1 additional ...
Terms matched: 2  -  Score: 23  -  16 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_July_2021.pdf
64. SilverSummit_DUR_Binder_July_2021.pdf
... SSHP Confidential 2021 Q1 2020 Q4 Sympathomimetics 5194 SSHP Confidential Sympathomimetics 4715 SSHP Confidential Proton Pump Inhibitors 3462 SSHP Confidential Proton Pump Inhibitors 3269 SSHP Confidential Central Muscle Relaxants 3344 ...
Terms matched: 1  -  Score: 33  -  15 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_July_2021.pdf
65. E-Binder_SSSB_June_2021.pdf
... CYP = cytochrome P450; BCRP = breast cancer resistance protein; IV = intravenous ... ® EPIDUO® RETIN-A MICRO®(Pump and Tube) TAZAROTENE TRETINOIN TRETIN-X® ...
Terms matched: 2  -  Score: 101  -  09 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_June_2021.pdf
66. Anti-Migraine_Agents_Misc_2021-07.pdf
... ‚ Avoid concomitant use with P-glycoprotein and breast cancer resistant protein substrates. DOSING AND ... 1 spray in be primed with 4 pumps. Migranal each nostril; 1 additional ...
Terms matched: 2  -  Score: 24  -  04 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anti-Migraine_Agents_Misc_2021-07.pdf
67. NV_PDL_20210528.pdf
... PEROXIDE TAZORAC® ATRALIN® ZIANA® AVITA® EPIDUO® RETIN-A MICRO®(Pump and Tube) TAZAROTENE TRETINOIN TRETIN-X® VELTIN® Electrolytic and Renal Agents Phosphate ...
Terms matched: 1  -  Score: 22  -  28 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_PDL_20210528.pdf
68. Scabicides_and_Pediculicides_2021-06.pdf
... manufacturer pediatric patients have not so it is unknown whether excreted been established. in breast milk; use with caution. Lindane Category C* Enters breast milk; ...
Terms matched: 1  -  Score: 74  -  06 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Scabicides_and_Pediculicides_2021-06.pdf
69. Calcitonin_(CGRP)_Inhibitors_2021-06.pdf
... . Abbreviations: CrCL = creatinine clearance; CYP = cytochrome P450; BCRP = breast cancer resistance protein; IV = intravenous; ODT = orally disintegrating tablet; ...
Terms matched: 1  -  Score: 11  -  06 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Calcitonin_(CGRP)_Inhibitors_2021-06.pdf
70. Irritable_Bowel_Syndrome_2021-06.pdf
... , constipation-inducing drugs (eg, alosetron, anticholinergics, opioids), OATP1B1 and breast cancer resistance protein (BCRP) substrates (eg, rosuvastatin), and ...
Terms matched: 1  -  Score: 11  -  06 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Irritable_Bowel_Syndrome_2021-06.pdf
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