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

Modernization Project

Important System Dates (Click for Calendar View)
  • Legacy (Old/Current) Medicaid System Code Freeze Starting Date: August 4, 2018
  • Paper Claims Appeals Submission Cut-off Date: January 11, 2019 [See Web Announcement: 1733]
  • Paper Claims Submission Cut-off Date: January 11, 2019 [See Web Announcement: 1733]
  • Paper Provider Enrollment Submission Cut-off Date: January 11, 2019 [See Web Announcement: 1733]
  • Cut-off Date to submit Physician-Administered Drug (PAD) Claims: January 18, 2019 (Until Modernization System Go-Live)
  • Cut-off Date to submit EDI/Payerpath Claims: January 24, 2019 (Until Modernization System Go-Live)
  • Paper Prior Authorizations Submission Cut-off Date: January 25, 2019 [See Web Announcement: 1733]
  • Execute Transition to Modernized MMIS: Beginning at 6pm Pacific Time on January 25, 2019 thru January 28, 2019. (Provider Portal Electronic Verification System (EVS) and Audio Voice Response are available all weekend. All other functions are unavailable.)
  • Modernized MMIS Soft Go Live: January 29, 2019. (All functions available, except Claims)
  • Modernized MMIS Claims Go Live: February 1, 2019
Known System Issues and Identified Workarounds
Helpful Resources

Modernization (New) Medicaid System Web Announcements

DateAnnouncement NumberTopic
Oct 01, 20191987Modernization: URGENT: Paper Submissions Are No Longer Returned to Providers
Sep 09, 20191967Modernization: FINAL REMINDER - Paper Submissions Will No Longer Be Returned
Aug 09, 20191942Modernization: Paper Submissions Will No Longer Be Returned
Jul 11, 20191927Modernization: Update Regarding Timely Filing Requirements Related to Retro-eligibility
Jul 11, 20191926Modernization Update: Date of Decision for Recipient Eligibility Available in Electronic Verification System (EVS)
Jul 09, 20191923Modernization: Paper Submissions Will No Longer Be Returned
Jun 28, 20191918Modernization: Attention All Providers: Some 2019 Procedure Codes Incorrectly Denied with Error Code 4014 (No Pricing Segment on File)
Jun 25, 20191917Modernization: Instructions for Provider Type 65 (Hospice, Long Term Care) Regarding Type of Bill
May 21, 20191899Modernization: Requirements for Completing an Application, Revalidation or Re-enrollment Differ for Individual Providers and Group Providers
Apr 29, 20191884Modernization: Attention All Providers: Update Regarding Customer Service Call Center Hours
Mar 29, 20191870Modernization: Attention All Providers: Instructions for Reading a Remittance Advice
Mar 28, 20191868Modernization: Attention Individual and Group Providers: Information Regarding How to Link and Unlink Providers
Mar 26, 20191866Modernization: Reminder for All Providers: Nevada Medicaid Is Now Paperless!
Mar 07, 20191853Modernization: New Claim Adjustment Reason Code Will Assist With Medicare Cost Reporting
Mar 01, 20191851Modernization: Instructions for Providers and Trading Partners Regarding SNIP Level 4 Edits
Feb 22, 20191847Modernization: Attention All Providers: Revalidate/Update Provider Information Process
Feb 21, 20191845Modernization: Attention All Providers: Update Regarding Expanded Customer Service Call Center Hours
Feb 13, 20191842Modernization: Attention All Providers: Reminders on Using the Modernized MMIS
Feb 12, 20191841Modernization: Instructions for Nursing Facilities, Intermediate Care Facilities and Hospice Providers Regarding Benefit Plan Details
Feb 08, 20191839Modernization: Attention All Providers: Inactive Provider Messages on the EVS Secure Provider Web Portal
Feb 08, 20191840Modernization: Attention Nursing Facilities (Provider Type 19): Select Appropriate Claim Type When Submitting Claims in Provider Web Portal
Feb 01, 20191834Modernization: Attention All Providers: New MMIS is Now Live!
Jan 31, 20191833Modernization Known System Issue: Date of Decision for Recipient Eligibility Not Currently Available
Jan 31, 20191832Modernization: Prior Authorization and Claims Webinars in February
Jan 31, 20191831Modernization: Attention Out-of-State Providers: Use the Online Provider Enrollment Tool to Enroll in Nevada Medicaid
Jan 30, 20191830Modernization: Attention All Providers: New MMIS is Going Live!
Jan 29, 20191828Modernization: Attention Inpatient Facility Providers Regarding Prior Authorization for Service Rendered Matching Service Billed on Claims
Jan 29, 20191827Modernization: Attention All Providers: Extended Customer Service Call Center Hours during MMIS Transition
Jan 29, 20191826Modernization: Instructions Regarding Letters of Agreement and Submitting the Corresponding Claims
Jan 29, 20191829Modernization: Attention Providers Using Outsourced Billing Agencies/Vendors
Jan 25, 20191825Modernization: Important Information and Dates All Trading Partners Need to Know to Prepare for Go-Live
Jan 25, 20191824Modernization: Attention All Providers Regarding New Registrations to Use the Secure Provider Web Portal
Jan 25, 20191823Modernization: Urgent Reminder for All Providers Regarding Prior Authorization Requests
Jan 24, 20191820Modernization: Attention All Providers: Physician-Administered Drug (PAD) Claims and Currently Pended Claims to be Denied
Jan 24, 20191821Modernization: Buy-In and Third Party Liability Related Transactions During Transition
Jan 23, 20191818Modernization: Reminder for All Providers: Use Current Procedure, Diagnosis and Value/Condition Codes on Claims
Jan 18, 20191816Modernization: Attention All Providers: Modernized MMIS Transition Overview – Important Dates and Instructions (Updated January 24, 2019)
Jan 18, 20191815Modernization: Computer-Based Trainings (CBTs) Are Now Available
Jan 16, 20191808Modernization: Attention All Providers: Clinical Laboratory Improvement Amendments (CLIA) Number Requirements
Jan 15, 20191807Modernization: Attention All Providers Who Did Not Register for Modernization Training: Training Opportunities Available
Jan 11, 20191806Modernization: Attention Waiver Providers: Submit Claims with the Prior Authorization Number
Jan 11, 20191805Modernization: Attention All Providers: Electronic Data Interchange (EDI) Enrollment Form Deadline and File Transactions Information (Updated January 22, 2019)
Jan 08, 20191801Modernization: Attention All Providers: New Instructions for Submitting Claim Adjustment and Void Requests as Paperless Processes Are Implemented
Jan 07, 20191799Modernization: Provider Web Portal Initial Log in After Implementation - New Password Required
Jan 04, 20191798Modernization: Attention Providers Who Submit Claims with National Drug Codes: Changes Regarding Making Adjustments to Claims with Physician-Administered Drug Details
Jan 04, 20191795Modernization: Attention Hospitals and Nursing Facilities: Prepare for PASRR Portal Temporary Shutdown
Dec 28, 20181791Modernization: Attention All Providers: New MMIS is Going Paperless!
Dec 28, 20181788Modernization: Reminder with Dates All Providers and Delegates Need to Know to Prepare for Paperless Processes
Dec 28, 20181787Modernization: Trading Partner Enrollment and Certification (Testing) Must Be Completed NOW to Avoid Any Service Interruptions
Dec 28, 20181792Modernization: Attention All Providers: Prior Authorization Requests and Related Documents Will Not Be Accepted by Fax or Mail as of January 26, 2019
Dec 18, 20181781Modernization: Attention All Providers: Changes Regarding Physician-Administered Drug Claims
Dec 13, 20181776Modernization: Attention All Providers: Changes Regarding Claims Submission of Medicare Crossover Claims
Dec 13, 20181775Modernization: Attention Inpatient Services Providers: Changes Regarding Patient Liability on Inpatient Claims (Updated November 4, 2019)
Dec 07, 20181769Modernization: Provider Training Enrollment Closes on December 31, 2018
Dec 03, 20181766Modernization: Trading Partner Enrollment and Certification (Testing) Must Be Completed Immediately to Avoid Any Service Interruptions
Nov 30, 20181763Modernization: Attention Outpatient Facility Providers: Changes Regarding Claims Submission
Nov 30, 20181762Modernization: Attention Inpatient Providers: Changes Needed When Submitting Claims for Processing
Nov 29, 20181761Modernization: Changes Regarding Rendering Provider’s National Provider Identifier on Professional Claims
Nov 28, 20181758Modernization: Attention Providers Enrolled with Atypical Provider Identifiers (APIs)
Nov 28, 20181757Modernization: Attention All Providers: Changes Regarding the Claim Appeal Request Process
Nov 21, 20181752Modernization: Attention Outpatient Providers: Reminder Regarding Ancillary Services
Nov 07, 20181739Modernization: Helpful Information Regarding Registering for Provider Training on Modernized MMIS
Nov 06, 20181738Modernization: Attention All Providers: Providers Will See New Edit Codes
Nov 05, 20181735Modernization: Attention All Providers: Include Claims Adjustment Reason Codes on Claims
Nov 01, 20181733Modernization: Dates All Providers and Delegates Need to Know to Prepare for Paperless Processes
Nov 01, 20181731Modernization: Attention Electronic Billing Trading Partners: Trading Partner Enrollment and Certification (Testing) Reminders
Nov 01, 20181730Modernization: Attention Provider Type 12 (Hospital, Outpatient): HCPCS Observation Code G0378 Limitation
Oct 25, 20181723Modernization: Reminder for Provider Type 29 (Home Health Agency) Regarding Billing with Value Codes
Oct 18, 20181714Modernization: Provider Training on Modernized MMIS Scheduled for January 2019
Oct 17, 20181712Modernization: Attention All Provider Types: DHCFP Proposes to Discontinue Atypical Provider Identifiers (APIs)
Oct 01, 20181703Modernization: Attention Electronic Billing Trading Partners: Preparations Continue for the Medicaid Management Information System Modernization Project – Trading Partner Enrollment and Certification (Testing)
Sep 26, 20181697Modernization: Electronic Funds Transfer Requirement Proposed for All Providers (Updated October 9, 2018)
Sep 17, 20181691Modernization: Provider Training Scheduled for January 2019; Modernization Project Webpage Created
Sep 12, 20181687Modernization: Attention All Providers: Upcoming Changes Include Electronic Claims Submission Requirement
Aug 31, 20181674Modernization: Attention Electronic Billing Trading Partners: Preparations Continue for the Medicaid Management Information System Modernization Project – Trading Partner Enrollment and Certification (Testing)
Aug 10, 20181659Modernization: Electronic Claims Submission for All Providers to be Implemented in February 2019
Aug 10, 20181658Modernization: Upcoming Physician-Administered Drug (PAD) Claim Requirements
Aug 06, 20181655Modernization: Attention Electronic Billing Trading Partners: Preparations Continue for the Medicaid Management Information System Modernization Project – Trading Partner Enrollment and Certification (Testing)
Jun 28, 20181629Modernization: Attention Electronic Billing Trading Partners: Update Regarding the Medicaid Management Information System Modernization Project – Inbound and Outbound Companion Guides Now Available
Jun 18, 20181617Modernization: Attention Electronic Billing Trading Partners: Preparations Continue for the Medicaid Management Information System Modernization Project – Inbound Companion Guides Now Available
May 31, 20181602Modernization: News Regarding Direct Data Entry Claims Solution for Providers and Allscripts-Payerpath Access
Apr 20, 20181574Modernization: Attention Electronic Billing Trading Partners and Providers: Preparations for the Medicaid Management Information System Modernization Project
Mar 28, 20181559Modernization: Attention All Providers and Electronic Billing Trading Partners: Medicaid Management Information System Enhancements Will Improve Claims and Enrollment Processes