Nevada Medicaid and Nevada Check Up News (Third 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]

Featured Links

DHCFP EVV

Authorization Criteria

DHCFP Home

EDI Information

EVS User Manual

Provider Flex

Online Provider Enrollment

Provider Login (EVS)

Prior Authorization

Search Fee Schedule

Search Providers

Claims

Trading Partner

Self-Paced Training Videos

Notifications

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, December 22, 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

Unwinding COVID-19 Information

Known System Issues-Click HERE

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 November 2024 Professional Claims. See Web Announcement 3509.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

Top Prior Authorization Denial Reasons for the Third Quarter of 2024. See Web Announcement 3488.

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.

Provider Links

DHCFP EVV

Billing Information

Forms

Provider Enrollment

Provider Newsletters

Provider Training

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

Electronic Claims / EDI

Effective February 1, 2019, all providers will be required to submit their Electronic Data Interchange (EDI) enrollment application electronically via the Provider Web Portal [https://www.medicaid.nv.gov/hcp/provider], as paper EDI application submissions will no longer be accepted with the go-live of the new modernized Medicaid Management Information System (MMIS). Please continue to review the modernization-related web announcements at https://www.medicaid.nv.gov/providers/Modernization.aspx for further details.

Electronic billing (also called Electronic Data Interchange or "EDI") speeds payment and eliminates costs associated with paper claims. You can submit electronic claims through a clearinghouse or through your existing, HIPAA-compliant business management software.


If you have any questions, please contact our EDI Coordinator at:
Telephone: (877) 638-3472

Trading Partner Enrollment and Certification (Testing) Documents
Title Date
Sample Compliant 835 Electronic Remit Aug. 31, 2018
Trading Partner User Guide Jan. 20, 2023
Trading Partner Agreement (TPA) Jan. 25, 2023
Trading Partner Fully Certified Report Feb. 11, 2019
EDI Announcements
Title Date
Electronic 837I Inpatient Claims with ICD-10 Codes Are Processing Appropriately Feb. 23, 2016
Claim Adjustment Reason Code for Presumptive Payment Adjustment on 837 Electronic Transactions Dec. 21, 2015
It’s 1 month until ICD-10 Codes Must Be Used on Claims with Dates of Service on or after October 1, 2015. Have You Tested to Ensure Claims will be Accepted and Processed? Sept. 1, 2015
ICD-10 Testing Encouraged before Implementation Date July 1, 2015
ICD-10 Testing and Facts Information June 11, 2015
EDI Announcement: Dual Use for 4010/5010 Formats Ends June 30, 2012 June 5, 2012
Anesthesia Services Claims Submitted Electronically (Updated May 31, 2012) May 4, 2012
EDI Announcement: Nevada Medicaid Version 5010 Solution Limits Diagnosis Codes on 837P Transactions. Apr. 30, 2012
EDI Announcement: Prepare for March 31, 2012, End Date for Dual Use of 5010 and D.0 Formats Jan. 25, 2012
Provider Billing Manual: EDI Chapter

The EDI chapter in the Provider Billing Manual provides answers to commonly asked EDI questions.

Read the chapter...

“Inbound” EDI Companion Guides
(The following Companion Guides are valid to use for the certification/testing to transition to the modernized MMIS and upon implementation of the MMIS Modernization Project in February 2019)
Title Date
Dental Health Care Claim: Fee-for-Service (837D) March 2020
Institutional Health Care Claim: Fee-for-Service (837I) July 2022
Professional Health Care Claim: Fee-for-Service (837P) July 2022
837 Health Care Claim/Encounter: Dental Encounter (837D) April 2021
837 Health Care Claim/Encounter: Institutional Encounter (837I) December 2024
837 Health Care Claim/Encounter: Professional Encounter (837P) December 2024
837 Health Care Claim/Encounter: Non-Emergency Transportation (NET) Professional Encounter (837P) January 2020
National Council for Prescription Drug Program (NCPDP) Encounter Claims Companion Guide February 2023
“Outbound” EDI Companion Guides
(The following Companion Guides are valid to use for the certification/testing to transition to the modernized MMIS and upon implementation of the MMIS Modernization Project in February 2019)
Title Date
Health Care Eligibility Benefit Inquiry and Information Response (270/271) May 2024
Health Care Claim Status Inquiry and Response (276/277) April 2019
Health Care Premium Payment (820) November 2019
Benefit Enrollment and Maintenance (834) August 2024
Health Care Payment/Advice (835) March 2019

The Companion Guides contain our HIPAA-compliant technical specifications for each transaction.