Nevada Medicaid and Nevada Check Up News (First Quarter 2018 Provider Newsletter) [Read]

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: The adjudication of claims for physician-administered drugs submitted last week may be delayed due to a claims processing issue. The claims may pend with edit code 0899 (National Drug Code (NDC) claims are pending during transition period) on remittance advices dated June 22, 2018. This notification will be updated when the issue is resolved and when the claims are processed.

Attention Electronic Billing Trading Partners: Preparations Continue for the Medicaid Management Information System Modernization Project – Inbound Companion Guides Now Available. [See Web Announcement 1617]

Attention All Providers and Electronic Billing Trading Partners: Medicaid Management Information System Enhancements Will Improve Claims and Enrollment Processes. [See Web Announcement 1559]

The Division of Health Care Financing and Policy (DHCFP) has selected LIBERTY Dental Plan of Nevada (LIBERTY) as the new Managed Care Dental Benefits Administrator (DBA) effective January 1, 2018, to serve recipients enrolled in a Managed Care Organization (MCO). [See Web Announcement 1442]

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

Sunday
8:00PM - 12:30AM

Provider Enrollment Online Application
Effective December 1, 2015, the web-based Online Provider Enrollment Portal is available for providers to complete new enrollment in Nevada Medicaid, revalidation and provider changes.

Thank you for your interest in the Nevada Medicaid and Nevada Check Up Program. This page contains all of the information and forms you will need to become a Nevada Medicaid provider. If you have any questions, please contact the Provider Enrollment Unit at (877) 638-3472 from 8a.m. to 5p.m. Monday through Friday.


Effective 12/1/2015, access Online Provider Enrollment for individual, group or OPR enrollments.


Provider Documentation Reminders: (See Web Announcement 1125 for reminders that will assist providers in adhering to the documentation responsibilities required of each Nevada Medicaid/Nevada Check Up provider.)


All enrollment documents including attachments require an original signature from the provider or an authorized representative (use dark blue or black ink).


Required Enrollment Documents
Online Provider Enrollment User Manual
Initial Enrollment Documents
Revalidation Documents
Ordering, Prescribing and Referring Provider Enrollment Documents
Hospital Presumptive Eligibility Documents
  • Web Announcement 1526:Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines for 2018 (Posted February 16, 2018)
  • Web Announcement 1408:Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines for the Remainder of 2017 and Early 2018 (Posted July 17, 2017)
  • Web Announcement 1008: Attention ALL Hospital Presumptive Eligibility Providers: Guidance Policy Available
  • Web Announcement 861 with Training Schedule: Implementation of Hospital Presumptive Eligibility Option for Acute Care Hospitals (Provider Types 11 and 75)
  • Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum: Qualified hospitals must complete and submit the Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum.
  • Hospital Presumptive Eligibility Training Sign-Up Sheet: Complete this form listing the hospital employees that will be attending the mandatory training for Presumptive Eligibility. You will be notified by the DWSS in regards to the training dates and times. Keep in mind that each employee making PE determinations MUST be trained by DWSS and complete a competency examination prior to making ANY determinations.
Recommended Enrollment Documents
Changes to Provider Information

Changes to any information presented on your enrollment documents must be reported to Nevada Medicaid within five business days.

  • To complete changes online, please login to the Secure Web Portal, and choose “Revalidate-Update Provider”.
  • To report a change in business ownership, resubmit a completed Provider Enrollment Application.
  • For all other changes, the Provider Information Change Form (FA-33) may be used.
Mailing Address

Mail completed enrollment forms and required documentation to Nevada Medicaid, Provider Enrollment Unit, P.O. Box 30042, Reno, NV 89520-3042