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]

Notifications

URGENT Electronic Visit Verification (EVV) Claims Message: EVV claims submitted through Sandata between noon Pacific Time on Monday, April 8, 2024, and 6 a.m. Pacific Time on Tuesday, April 9, 2024, were received for processing by Gainwell on Wednesday, April 17, 2024. As a result, payment of the impacted claims will be unfortunately delayed by one week and paid April 26, 2024, instead of April 19, 2024. No action is required on your part. Nevada Medicaid is working to avoid this happening again in the future and apologizes for the inconvenience this payment delay causes during this period of EVV claim submission challenges because of the Change Healthcare cyber security event.

URGENT Electronic Visit Verification (EVV) Claims Message: EVV claims submitted through Sandata after noon Pacific Time last Thursday, April 4, 2024, were received for processing by Gainwell on Monday, April 8, 2024. As a result, payment of the impacted claims will be unfortunately delayed by one week and paid April 19, 2024, instead of April 12, 2024. No action is required on your part. Nevada Medicaid is working with Sandata to avoid this happening again in the future and apologizes for the inconvenience this payment delay causes during this period of EVV claim submission challenges because of the Change Healthcare cyber security event.

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.

URGENT NOTIFICATION: Physician Administered Drug (PAD) claims may be experiencing a host eligibility error. The impacted claims will be reprocessed automatically. No action is needed by providers.

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

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.

Scheduled Site Maintenance

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


Effective February 1, 2019, all providers will be required to submit their claims electronically (using Trading Partners or Direct Data Entry [DDE]), as paper claims submission will no longer be accepted.

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Web Announcement 1711]


FAQs: National Correct Coding Initiative (NCCI) Claim Review Edits [Review Now]

Clinical Claim Editor FAQs Updated December 5, 2011 [Review Now]

Third Party Liability Frequently Asked Questions [Review Now]


COVID-19 Billing Guides Archives Click here


Remittance Advice Reference Material
Title Last Update
Claim Error/EOB/ANSI Code Crosswalk 04/09/2024
Accounts Receivable Financial Reason Codes 10/09/2020

Billing Manual
For Archives Click here

Title File Size Last Update
Billing Manual 2 MB 03/13/2024

Billing Guidelines (by Provider Type)
For Archives Click here

Provider Type Title Last Update
10 Outpatient Surgery, Hospital Based | Rates 02/03/20
11 Hospital, Inpatient 03/14/24
12 Hospital, Outpatient 03/03/22
13 Psychiatric Hospital, Inpatient 02/03/20
14 Behavioral Health Outpatient Treatment | Outpatient Mental Health Treatment Plan Fact Sheet 04/09/24
15 Registered Dietitian 12/16/19
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 11/25/19
17 Special Clinics 03/01/24
17 (Spec. 169) Special Clinics: Freestanding Birthing Centers 10/12/21
17 (Spec. 179) Special Clinics: School Based Health Centers (SBHC) 01/25/19
17 (Spec. 181) Special Clinics: Federally Qualified Health Centers (FQHC) 08/30/19
17 (Spec. 188) Special Clinics: Certified Community Behavioral Health Center (CCBHC) | CCBHC Allowable Services | FQHC-CCBHC Allowable Services 12/06/23
17 (Spec. 215) Special Clinics: Substance Use Agency Model (SUAM) 04/09/24
19 Nursing Facility 08/24/23
20 Physician, M.D., Osteopath, D.O. 04/24/23
21 Podiatrist 06/27/18
22 Dentist | Attachment A: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements | Attachment B: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements for Dental Services for the Waiver for Individuals with Intellectual and Developmental Disabilities 03/27/23
23 Hearing Aid Dispenser & Related Supplies 06/08/20
24 Advanced Practice Registered Nurses 04/24/23
25 Optometrist 10/06/23
26 Psychologist 03/18/22
27 Radiology and Non-invasive Diagnostic Centers 02/25/20
28 Pharmacy: Billing Manual n/a
29 Home Health Agency and Private Duty Nursing Services 04/11/24
30 Personal Care Services - Provider Agency 01/31/19
32 (Spec. 249) Community Paramedicine 11/04/19
32 (Spec. 932) Ambulance, Air or Ground 12/07/21
33 Durable Medical Equipment (DME), Disposable, Prosthetics 02/17/23
34 Therapy 11/21/23
35 (Spec. 987) Non-Emergency Secure Behavioral Health Transports 07/19/21
36 Chiropractor 12/05/11
38 Waiver for Individuals with Intellectual and Developmental Disabilities 07/14/22
39 Adult Day Health Care 03/09/20
41 Optician, Optical Business 10/06/23
43 Laboratory, Pathology Clinical 04/10/24
44 Swing-bed, Acute Hospital 11/25/19
45 End Stage Renal Disease (ESRD) Facility 02/03/21
46 Ambulatory Surgical Centers 12/30/19
47 Indian Health Services (IHS) and Tribal Clinics 05/01/20
48 Home and Community Based Waiver for the Frail Elderly 06/22/23
51 Indian Health Service Hospital, Inpatient (Tribal) 12/02/19
52 Indian Health Service Hospital, Outpatient (Tribal) 12/02/19
54 Targeted Case Management 06/17/20
55 Day and Residential Habilitation Services 03/23/21
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 12/03/19
57 Home and Community Based Waiver for the Frail Elderly in Residential Facilities for Groups 01/25/21
58 Home and Community Based Waiver for Persons with Physical Disabilities 12/12/22
59 Home and Community Based Waiver for the Frail Elderly in an Assisted Living Facility 05/24/23
60 School Health Services (SHS) 08/10/23
63 Residential Treatment Centers (RTC) 01/20/22
64 Hospice 04/21/21
65 Hospice, Long Term Care 01/26/23
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Private 11/25/19
72 Nurse Anesthetist 12/05/11
74 Nurse Midwife 11/14/22
75 Critical Access Hospital (CAH), Inpatient 03/14/24
76 Audiologist 06/08/20
77 Physician's Assistant 04/24/23
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 12/02/19
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 12/02/19
81 Hospital Based ESRD Provider 02/03/21
82 Behavioral Health Rehabilitative Treatment 04/09/24
83 Personal Care Services - Intermediary Service Organization 01/31/19
85 Applied Behavior Analysis (ABA) 03/06/24
86 Specialized Foster Care | Specialized Foster Care Needs Based Eligibility Checklist 09/21/23
89 Community Health Workers 02/01/22
90 Doula Services 02/13/23
91 Pharmacist 06/30/22

Billing Instructions (by Service Type)
Title Last Update
Anesthesia 04/21/22
Emergency Medicaid Only (EMO) 02/07/23
Medication-Assisted Treatment (MAT) Services for Opioid Dependence 07/05/23
Preventive Services 05/04/20
Sterilization and Abortion Policy 07/29/22
Telehealth 02/22/23