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]

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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 August 2024 Professional Claims. See Web Announcement 3448.

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

Top Prior Authorization Denial Reasons for the Second Quarter of 2024. See Web Announcement 3427.

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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DateAnnouncement NumberTopic
Oct 03, 20243454Medicaid Services Manual Chapters Updated
Oct 01, 20243453Updates to Coverage and Reimbursement of COVID-19 Products
Sep 30, 20243452Attention Provider Type 93 (Substance Use Treatment): Enrollment Clarification for Alcohol and Drug Counselors with a Provisional Certificate License
Sep 30, 20243451Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Sep 26, 2024Volume 21 Issue 3Nevada Medicaid and Nevada Check Up News (Third Quarter 2024 Provider Newsletter)
Sep 26, 20243450Changes made to Diabetic Supplies Preferred Product List effective September 26, 2024
Sep 24, 20243449Attention Provider Types 34 (Therapy) and 85 (Applied Behavior Analysis): Some Procedure Codes Billed with Place of Service Code 10 Now Deny With Error Code 679
Sep 23, 20243448Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2024 Professional Claims
Sep 20, 20243447Lung Therapy Component Recall: Baxter Healthcare Corporation Recalls Certain Volara System Single-Patient Use Circuits and Blue Ventilator Adapter Assemblies Due to Disconnection Risk That May Prevent Proper Ventilation
Sep 17, 20243446Attention Provider Type 38 (Waiver for Individuals with Intellectual and Developmental Disabilities): Procedure Code T2025 Modifiers are Replacing Procedure Code T2017 Modifiers When Billed with T2016
Sep 17, 20243445Medicaid Management Information System Updated with NCCI Quarter 4 2024 Files
Sep 17, 20243444Attention Provider Type 60 (School Health Services (SHS)): Claims for Procedure Code 92551 No Longer Deny with Error Code 5506
Sep 17, 20243443New Error Code Implemented for New Patient Codes Billed for the Same Recipient Within Three Years
Sep 16, 20243442Attention Provider Type 85 (Applied Behavior Analysis): Age Limit for Applied Behavior Analysis Services Removed
Sep 13, 20243441Attention Provider Type 12 (Hospital, Outpatient): Provider-Specific Rates Updated for Critical Access Hospitals (Updated October 3, 2024)
Sep 13, 20243440The Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula) is Excluded from Coverage
Sep 12, 20243439Attention All Providers, Delegates and Staff: Upcoming Training Sessions for October 2024
Sep 11, 20243438Attention Provider Type 63 (Residential Treatment Centers (RTC)): Reminder for Submitting Claims with Leave of Absence Days
Sep 11, 20243437Medicaid Services Manual Chapters Updated
Sep 11, 20243436Attention All Providers: Healthcare Common Procedure Coding System (HCPCS) Code Q5126 Open for Billing
Sep 10, 20243435Attention Provider Type 22 (Dentist): New Dental Procedure Codes Open for Billing for Intellectual and Development Disabilities (IDD) Recipients
Sep 10, 20243434Claims Impacted by National Correct Coding Initiative Quarter 4 2023 Replacement Files Have Been Reprocessed
Sep 10, 20243433New Error Code to be Implemented for New Patient Codes Billed for the Same Recipient Within Three Years
Sep 05, 20243432Attention Provider Type (PT) 17 (Special Clinics) Specialty 188 (Certified Community Behavioral Health Center (CCBHC)): Two Claim Reprocessing Efforts
Sep 04, 20243431Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 25 (Optometrist) and 41 (Optician, Optical Business): Prior Authorization No Longer Required for Procedure Code V2784
Sep 03, 20243430New Provider Type 87 (Crisis Services) Available for Enrollment
Sep 03, 20243429Attention All Providers: Claims for Evaluation & Management (E&M) Services with a Diagnosis Code Related to Surgical Procedures Will Deny
Aug 28, 20243428Attention Provider Types 11 (Inpatient) and 75 (Critical Access Hospital (CAH)): Hospital Presumptive Eligibility (HPE) Training Calendar Dates
Aug 28, 20243427Attention All Providers: Top Prior Authorization Denial Reasons for the Second Quarter of 2024
Aug 28, 20243426Attention Provider Type 60 (School Health Services (SHS)): Claims for Procedure Codes 92507, 92508 and 92526 No Longer Deny with Error Code 5537
Aug 26, 20243425Error Code 3030 Update for Physician Administered Drug (PAD) Claims: Claims Now Deny with Error Code 3031
Aug 26, 20243424Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2024 Professional Claims
Aug 22, 20243423Autism Spectrum Disorder (ASD) Diagnosis Certification for Requesting Initial Applied Behavior Analysis (ABA) Services (Form FA-11F) Updated
Aug 20, 20243422Attention Provider Type 38 (Waiver for Individuals with Intellectual and Developmental Disabilities): Ownership or Interest Must be Disclosed when Enrolling
Aug 19, 20243421Attention All Providers: New Provider Expenditures Report
Aug 19, 20243420Attention All Providers: Professional and Institutional Claims That Paid in Error Have Been Reprocessed
Aug 16, 20243419Attention Provider Type 55 (Day and Residential Habilitation Services): Update Regarding Specialty 315 for Day Habilitation and Specialty 316 for Residential Habilitation
Aug 15, 20243418Attention All Providers, Delegates and Staff: Upcoming Training Sessions for September 2024
Aug 14, 20243417Attention Provider Type 91 (Pharmacist): Opioid Use Disorder (OUD) Procedure Codes
Aug 14, 20243416Attention Provider Types 10 (Outpatient Surgery, Hospital Based), 12 (Hospital, Outpatient) and 46 (Ambulatory Surgical Centers, Freestanding): Additional Coverage for Gender Dysphoria and Gender Incongruence
Aug 14, 20243415Reminder: Multi-Factor Authentication Coming Soon!
Aug 12, 20243414Attention Provider Type (PT) 20 (Physician, M.D., Osteopath, D.O.), PT 24 (Advanced Practice Registered Nurses) and 74 (Nurse Midwife): 5% Rate Increase Approved for PT 20 and Rate Parity for PT 24 and PT 74
Aug 08, 20243413Attention All Providers: Nevada Medicaid ChatBot
Aug 07, 20243412Attention Provider Types 45 (End Stage Renal Disease (ESRD) Facility) and 81 (Hospital Based ESRD Provider): Rates for Dialysis Codes 90999 and 90945 Adjusted for 2024
Aug 07, 20243411Attention Provider Type 19 (Nursing Facility) and 65 (Hospice, Long Term Care): State Fiscal Year 2025 Quarter 1 Rate Updates Implemented
Aug 06, 20243410Medicaid Services Manual Chapter 1200 Updated
Aug 06, 20243409Attention All Providers and Partners: Nevada Medicaid Creates Email List to Assist With Justice Involved Reentry Initiative
Aug 05, 20243408Drug Use Review (DUR) Board approves changes to Standard PDL Exception Criteria
Aug 05, 20243407Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Aug 05, 20243406Drug Use Review (DUR) Board approves changes effective August 5, 2024
Aug 01, 20243405Attention Provider Type 60 (School Health Services): Claims for Procedure Code 92551 with Modifier 52
Aug 01, 20243404Attention All Providers: New Medical Equipment Searchable Spreadsheet and Trifold
Jul 30, 20243403Attention All Providers: Update to Physician-Administered Drug (PAD) Claims Pricing Process
Jul 23, 20243402Attention Provider Type (PT) 85 (Applied Behavior Analysis) Providers: Instructions for Claim Submission When ABA Services are Rendered in a Psychiatric Hospital (PT 13) or a Residential Treatment Center (PT 63)
Jul 19, 20243401Attention All Providers, Delegates and Staff: Upcoming Training Sessions for August 2024
Jul 19, 20243400Attention Provider Type (PT) 85 (Applied Behavioral Analysis) and PT 63 (Inpatient Psychiatric Residential Treatment