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

Modernization Project

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, November 24, 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 September 2024 Professional Claims. See Web Announcement 3465.

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.

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

Silver State Scripts Board Clinical Meeting Information

Month Title
March 2022 For Review at March 24, 2022, Meeting: Acne Agents
March 2022 For Review at March 24, 2022, Meeting: Attention-Deficit/Hyperactivity Disorder (ADHD) Agents
March 2022 For Review at March 24, 2022, Meeting: Dopamine Agents
March 2022 For Review at March 24, 2022, Meeting: Multiple Sclerosis Agents
March 2022 For Review at March 24, 2022, Meeting: Ophthalmic Anti-Allergy
December 2021 For Review at December 9, 2021, Meeting: Angiotensin-Converting Enzyme (ACE) Inhibitors
December 2021 For Review at December 9, 2021, Meeting: Antipsychotics, Atypicals
December 2021 For Review at December 9, 2021, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
December 2021 For Review at December 9, 2021, Meeting: Cardiovascular Agents, Miscellaneous
December 2021 For Review at December 9, 2021, Meeting: Electrolyte Depleters
December 2021 For Review at December 9, 2021, Meeting: Glucagon Agents
December 2021 For Review at December 9, 2021, Meeting: Incretin Mimetics and Amylinomimetics
December 2021 For Review at December 9, 2021, Meeting: Movement Disorder Agents
December 2021 For Review at December 9, 2021, Meeting: Neuropathic Pain and Fibromyalgia Agents
December 2021 For Review at December 9, 2021, Meeting: Ophthalmic Immunomodulators
December 2021 For Review at December 9, 2021, Meeting: Opioid Use Disorder Agents
December 2021 For Review at December 9, 2021, Meeting: Urinary Antispasmodics
September 2021 For Review at September 23, 2021, Meeting: Acne Agents
September 2021 For Review at September 23, 2021, Meeting: Attention-Deficit/Hyperactivity Disorder (ADHD) Agents
September 2021 For Review at September 23, 2021, Meeting: Bile Acid Sequestrants
September 2021 For Review at September 23, 2021, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
September 2021 For Review at September 23, 2021, Meeting: Carbidopa/Levodopa Agents
September 2021 For Review at September 23, 2021, Meeting: Cystic Fibrosis – Inhaled Antibiotics
September 2021 For Review at September 23, 2021, Meeting: Gout – Anti-Gout Agents
September 2021 For Review at September 23, 2021, Meeting: Immunomodulators
September 2021 For Review at September 23, 2021, Meeting: Incretin Mimetics and Amylinomimetics
September 2021 For Review at September 23, 2021, Meeting: Insulin and Combination Agents
September 2021 For Review at September 23, 2021, Meeting: Lidocaine (Added to this list on August 27, 2021)
September 2021 For Review at September 23, 2021, Meeting: Multiple Sclerosis Agents
September 2021 For Review at September 23, 2021, Meeting: Narcolepsy Agents
September 2021 For Review at September 23, 2021, Meeting: Ophthalmic Anti-Allergy
September 2021 For Review at September 23, 2021, Meeting: Pancreatic Enzymes
September 2021 For Review at September 23, 2021, Meeting: Respiratory Beta-Agonist Combination Agents
September 2021 For Review at September 23, 2021, Meeting: Respiratory Beta-Agonists
September 2021 For Review at September 23, 2021, Meeting: Respiratory Corticosteroids
September 2021 For Review at September 23, 2021, Meeting: Statins (HMG-CoA Reductase Inhibitors)
September 2021 For Review at September 23, 2021, Meeting: Triptans
June 2021 For Review at June 24, 2021, Meeting: Antipsychotics, Atypicals
June 2021 For Review at June 24, 2021, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
June 2021 For Review at June 24, 2021, Meeting: Familial Hypercholesterolemia Agents
June 2021 For Review at June 24, 2021, Meeting: Irritable Bowel Syndrome and Constipation Agents
June 2021 For Review at June 24, 2021, Meeting: Ophthalmic Agents, Intraocular Pressure (IOP)-Modifying
June 2021 For Review at June 24, 2021, Meeting: Opioids, Long Acting
June 2021 For Review at June 24, 2021, Meeting: Scabicides and Pediculicides
March 2021 For Review at March 25, 2021, Meeting: Antiemetics
March 2021 For Review at March 25, 2021, Meeting: Beta-Adrenergic Blocking Agents
March 2021 For Review at March 25, 2021, Meeting: Insulin and Combination Agents
March 2021 For Review at March 25, 2021, Meeting: Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
March 2021 For Review at March 25, 2021, Meeting: Urinary Antispasmodics
December 2020 For Review at December 10, 2020, Meeting: Anticonvulsants
December 2020 For Review at December 10, 2020, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
December 2020 For Review at December 10, 2020, Meeting: GnRH Modulators
December 2020 For Review at December 10, 2020, Meeting: Multiple Sclerosis Agents
December 2020 For Review at December 10, 2020, Meeting: Ophthalmic Immunomodulators
December 2020 For Review at December 10, 2020, Meeting: Respiratory Beta-Agonist Combination Agents
September 2020 For Review at September 24, 2020, Meeting: Acne Agents
September 2020 For Review at September 24, 2020, Meeting: Antiasthmatic – Monoclonal Antibodies
September 2020 For Review at September 24, 2020, Meeting: Anticonvulsants
September 2020 For Review at September 24, 2020, Meeting: Antiemetics
September 2020 For Review at September 24, 2020, Meeting: Anti-gout Agents
September 2020 For Review at September 24, 2020, Meeting: Antihistamines, Second-generation
September 2020 For Review at September 24, 2020, Meeting: Antihyperlipidemics, Miscellaneous
September 2020 For Review at September 24, 2020, Meeting: Antivirals, Topical
September 2020 For Review at September 24, 2020, Meeting: Attention-Deficit/Hyperactivity Disorder (ADHD) Agents
September 2020 For Review at September 24, 2020, Meeting: Benign Prostatic Hyperplasia Agents
September 2020 For Review at September 24, 2020, Meeting: Calcium Channel Blockers
September 2020 For Review at September 24, 2020, Meeting: Cephalosporins, Third-generation
September 2020 For Review at September 24, 2020, Meeting: Electrolyte Depleters
September 2020 For Review at September 24, 2020, Meeting: Immunomodulators
September 2020 For Review at September 24, 2020, Meeting: Incretin Mimetics and Amylinomimetics
September 2020 For Review at September 24, 2020, Meeting: Inflammatory Bowel Disease Agents
September 2020 For Review at September 24, 2020, Meeting: Insulin and Combination Agents
September 2020 For Review at September 24, 2020, Meeting: Irritable Bowel Syndrome and Constipation Agents
September 2020 For Review at September 24, 2020, Meeting: Multiple Sclerosis Agents
September 2020 For Review at September 24, 2020, Meeting: Neuropathic Pain and Fibromyalgia Agents
September 2020 For Review at September 24, 2020, Meeting: Ophthalmic Corticosteroids
September 2020 For Review at September 24, 2020, Meeting: Ophthalmics, Antibiotics and Combinations
September 2020 For Review at September 24, 2020, Meeting: Opioid Use Disorder Agents
September 2020 For Review at September 24, 2020, Meeting: Platelet Aggregation Inhibitors
September 2020 For Review at September 24, 2020, Meeting: Pulmonary Arterial Hypertension Agents
September 2020 For Review at September 24, 2020, Meeting: Respiratory Beta-Agonist Combination Agents
September 2020 For Review at September 24, 2020, Meeting: Respiratory Beta-Agonists
September 2020 For Review at September 24, 2020, Meeting: Sodium-Glucose Cotransporter-2 Inhibitors
September 2020 For Review at September 24, 2020, Meeting: Statins (HMG-CoA Reductase Inhibitors)
September 2020 For Review at September 24, 2020, Meeting: Urinary Antispasmodics
June 2020 For Review at June 25, 2020, Meeting: Attention-Deficit/Hyperactivity Disorder (ADHD) Agents
June 2020 For Review at June 25, 2020, Meeting: Atypical Antipsychotics
June 2020 For Review at June 25, 2020, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
June 2020 For Review at June 25, 2020, Meeting: Calcium Channel Blockers
June 2020 For Review at June 25, 2020, Meeting: Glucagon Agents
June 2020 For Review at June 25, 2020, Meeting: Insulin and Combination Agents
June 2020 For Review at June 25, 2020, Meeting: Multiple Sclerosis Agents
June 2020 For Review at June 25, 2020, Meeting: Narcolepsy Agents
June 2020 For Review at June 25, 2020, Meeting: Ophthalmic Agents, Intraocular Pressure (IOP)-Modifying
June 2020 For Review at June 25, 2020, Meeting: Ophthalmic Anti-Allergy
June 2020 For Review at June 25, 2020, Meeting: Reyvow™ (Lasmiditan)
June 2020 For Review at June 25, 2020, Meeting: Sodium-Glucose Cotransporter-2 Inhibitors)
June 2020 For Review at June 25, 2020, Meeting: Triptans
March 2020 For Review at March 26, 2020, Meeting: Angiotensin-Converting Enzyme (ACE) Inhibitors
March 2020 For Review at March 26, 2020, Meeting: Antiasthmatic – Monoclonal Antibodies
March 2020 For Review at March 26, 2020, Meeting: Anticonvulsants
March 2020 For Review at March 26, 2020, Meeting: Antipsoriatic Agents
March 2020 For Review at March 26, 2020, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
March 2020 For Review at March 26, 2020, Meeting: Incretin Mimetics and Amylinomimetics
March 2020 For Review at March 26, 2020, Meeting: Intranasal Allergic Rhinitis Agents
March 2020 For Review at March 26, 2020, Meeting: Opioids, Long Acting
March 2020 For Review at March 26, 2020, Meeting: Opioid Use Disorder Agents
December 2019 For Review at December 5, 2019, Meeting: Antiasthmatic – Monoclonal Antibodies
December 2019 For Review at December 5, 2019, Meeting: Anticonvulsants
December 2019 For Review at December 5, 2019, Meeting: Anti-Migraine Agents (Triptans)
December 2019 For Review at December 5, 2019, Meeting: Antipsoriatic Agents
December 2019 For Review at December 5, 2019, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
December 2019 For Review at December 5, 2019, Meeting: Incretin Mimetics and Amylinomimetics
December 2019 For Review at December 5, 2019, Meeting: Intranasal Allergic Rhinitis Agents
December 2019 For Review at December 5, 2019, Meeting: Opioids, Long Acting
December 2019 For Review at December 5, 2019, Meeting: Opioids, Short Acting
December 2019 For Review at December 5, 2019, Meeting: Opioid Use Disorder Agents
September 2019 For Review at September 26, 2019, Meeting: Angiotensin II Receptor Blockers (ARBs)
September 2019 For Review at September 26, 2019, Meeting: Antiemetics
September 2019 For Review at September 26, 2019, Meeting: Anti-inflammatory Agents – Misc., Topical
September 2019 For Review at September 26, 2019, Meeting: Anti-migraine Agents (Triptans)
September 2019 For Review at September 26, 2019, Meeting: Antivirals, Influenza
September 2019 For Review at September 26, 2019, Meeting: Antivirals, Topical
September 2019 For Review at September 26, 2019, Meeting: Attention-Deficit/Hyperactivity Disorder (ADHD) Agents
September 2019 For Review at September 26, 2019, Meeting: Atypical Antipsychotics
September 2019 For Review at September 26, 2019, Meeting: Biguanides
September 2019 For Review at September 26, 2019, Meeting: Calcitonin Gene Related Peptide (CGRP) Inhibitors
September 2019 For Review at September 26, 2019, Meeting: Calcium Channel Blockers
September 2019 For Review at September 26, 2019, Meeting: Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
September 2019 For Review at September 26, 2019, Meeting: Erythropoiesis Stimulating Agents
September 2019 For Review at September 26, 2019, Meeting: Hepatitis C Direct-Acting Antivirals
September 2019 For Review at September 26, 2019, Meeting: Immunomodulators
September 2019 For Review at September 26, 2019, Meeting: Inflammatory Bowel Disease Agents
September 2019 For Review at September 26, 2019, Meeting: Incretin Mimetics and Amylinomimetics
September 2019 For Review at September 26, 2019, Meeting: Inhaled Aminoglycosides
September 2019 For Review at September 26, 2019, Meeting: Insulin and Combination Agents
September 2019 For Review at September 26, 2019, Meeting: Macrolides
September 2019 For Review at September 26, 2019, Meeting: Meglitinides
September 2019 For Review at September 26, 2019, Meeting: Narcolepsy Agents
September 2019 For Review at September 26, 2019, Meeting: Omega-3 Fatty Acids
September 2019 For Review at September 26, 2019, Meeting: Opioids, Long Acting
September 2019 For Review at September 26, 2019, Meeting: Opioids, Short Acting
September 2019 For Review at September 26, 2019, Meeting: Opioid Use Disorder Agents
September 2019 For Review at September 26, 2019, Meeting: Proton Pump Inhibitors
September 2019 For Review at September 26, 2019, Meeting: Pulmonary Arterial Hypertension Agents
September 2019 For Review at September 26, 2019, Meeting: Respiratory Beta-Agonist Combination Agents
September 2019 For Review at September 26, 2019, Meeting: Scabicides and Pediculicides
September 2019 For Review at September 26, 2019, Meeting: Sodium-Glucose Cotransporter-2 Inhibitors
September 2019 For Review at September 26, 2019, Meeting: Statins (HMG-CoA Reductase Inhibitors)
September 2019 For Review at September 26, 2019, Meeting: Sulfonylureas
September 2019 For Review at September 26, 2019, Meeting: Thiazolidinediones