Home care billing · NV
Home care billing in Nevada
Short answer
Home care billing in Nevada is mostly fee-for-service. MSM Chapter 3600 keeps 1915(c) waiver enrollees, the aged, blind and disabled category and hospice patients out of the five health plans, so their personal care, waiver and home health claims go to the fiscal agent.
Personal care and home health need a prior authorization from Nevada Medicaid's QIO-like vendor before services start, every personal care visit has to sit in Sandata or another approved EVV system, and the claim has to reach the fiscal agent within 180 days. A dedicated Remitwright biller ties each authorization to its claims, serving Nevada agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for Nevada home care billing
| Fact | In Nevada | Source |
|---|---|---|
| Programs that pay | HCBS Waiver for the Frail Elderly (0152.R08.00); HCBS Waiver for Persons with Physical Disabilities (4150.R07.00); Waiver for Structured Family Caregiving (2426.R00.00); HCBS Waiver for Individuals with Intellectual and Developmental Disabilities (0125.R08.00); Personal Care Services, Medicaid State Plan (MSM Chapter 3500); Home Health Agency services, Medicaid State Plan (MSM Chapter 1400) | 1 |
| How it is delivered | Managed care and fee-for-service, split by who the recipient is | 2 |
| EVV | Open Choice Model | 5 |
| Medicare home health and hospice | National Government Services, Jurisdiction 6 | 11 |
Programs that pay for home care in Nevada1
HCBS Waiver for the Frail Elderly (0152.R08.00)
Case management, homemaker, respite, adult companion, adult day care, augmented personal care, chore, home delivered meals and personal emergency response system services, for people 65 and older who meet a nursing facility level of care.
MSM Chapter 2200 has the Aging and Disability Services Division and the Division of Welfare and Supportive Services decide eligibility, and nothing is reimbursed until the person is found eligible and the service is prior authorized.
HCBS Waiver for Persons with Physical Disabilities (4150.R07.00)
Case management, homemaker, respite, assisted living services, attendant care, chore services, environmental accessibility adaptations, home delivered meals, personal emergency response system services and specialized medical equipment and supplies, for people with physical disabilities of any age and people 65 and older who meet a nursing facility level of care.
Waiver for Structured Family Caregiving (2426.R00.00)
Case management, respite and structured family caregiving, for people 65 and older and people under 65 with other disabilities who meet a nursing facility level of care.
Structured family caregiving respite, billed under provider type 95 with specialty 191, is on Nevada Medicaid's list of provider types that must record visits in an EVV system.
HCBS Waiver for Individuals with Intellectual and Developmental Disabilities (0125.R08.00)
Day habilitation, prevocational services, residential support, supported employment, behavioral consultation, training and intervention, benefits counseling, career planning, counseling, dental services, individual directed goods and services, non-medical transportation, nursing services, nutrition counseling and residential support management, for people with intellectual disabilities of any age who meet an ICF/IID level of care.
Personal Care Services, Medicaid State Plan (MSM Chapter 3500)
Hands-on help or cueing with activities of daily living and instrumental activities of daily living, at home or wherever the need occurs, in the amount a Functional Assessment Service Plan supports, through an enrolled provider agency (provider type 30) or the self-directed model in MSM Chapter 2600.
Legally responsible individuals cannot be paid for state plan personal care, and the chapter's rules, prior authorization included, apply to Nevada Check Up as well.
Home Health Agency services, Medicaid State Plan (MSM Chapter 1400)
Intermittent skilled nursing, physical, occupational and speech therapy, and home health aide or certified nursing aide visits in the recipient's residence under a physician's Plan of Care, with respiratory therapy and dietitian services covered within limits.
How the program is delivered
Both, split by who the recipient is. Statewide managed care has covered rural and urban counties since January 1, 2026, and Nevada Medicaid's Contact a Health Plan page lists the health plans as Anthem Blue Cross and Blue Shield, CareSource Healthcare, Health Plan of Nevada, Molina Healthcare of Nevada and SilverSummit Healthplan, with Liberty Dental Plan of Nevada for dental. MSM Chapter 3600 excludes from managed care anyone enrolled in a 1915(c) HCBS waiver, recipients in Medical Assistance to the Aged, Blind and Disabled, recipients receiving hospice, ICF/IID residents and nursing facility stays beyond 180 days, and it places 1915(c) waiver services, adult day health care and day and residential habilitation outside the plan benefit.2 Nevada Medicaid's statewide managed care page puts about 126,000 people in fee-for-service, among them seniors 65 and older, people with disabilities and everyone enrolled in a home and community-based waiver program. Personal care and home health are not on the Chapter 3600 carve-out list, and the chapter names members receiving long-term services such as personal care or home health in its transition of care rules, so for a plan member the health plan is the payer to check first. A member admitted to hospice is disenrolled from the plan at once.
Electronic visit verification
Open Choice Model: Sandata Technologies is Nevada Medicaid's contracted EVV vendor, and providers that already run an EVV system may keep using it. The system has to verify the service type, the person receiving it, the date, the location, the person delivering it and the start and end times.5 MSM Chapter 3500 makes the visit record a condition of payment: personal care must be performed under the approved service plan, prior authorized and documented in an approved EVV system. MSM Chapter 1400 has required home health agencies to use a Cures Act compliant EVV system since January 1, 2024, and both chapters point to MSM Addendum B for the system requirements. CMS lists Nevada compliant for personal care EVV by January 1, 2021 and for home health EVV as of January 1, 2024.
Services under EVV5
- Home health care services (provider type 29)
- Personal care services (provider types 30 and 83)
- Attendant care, homemaker, chore, respite and companion care (provider types 48 and 58)
- Structured family caregiving respite (provider type 95, specialty 191)
Authorizations
Through Nevada Medicaid's QIO-like vendor. For state plan personal care the vendor confirms the person meets program criteria, an enrolled physical or occupational therapist completes the Functional Assessment Service Plan in the home, and the vendor issues a prior authorization number to the agency the recipient chose. Services that were not prior authorized are not reimbursed, initial or ongoing.6 Annual updates are recommended 60 to 90 days before the current authorization expires, on Form FA-24 with the units and dates of service requested, and a significant change in condition goes back to the vendor as soon as it happens. For waiver services the case manager builds the person-centered Plan of Care: MSM Chapter 2200 lets providers deliver only what is on that plan, with a prior authorization where one is required, and treats the units on the plan as the most the fiscal agent will pay unless the case manager approves a temporary increase.
Where the claims go
To the fiscal agent, electronically, for fee-for-service recipients. A claim is timely only if the fiscal agent receives it within 180 days of the date of service or of the eligibility decision, whichever is later, or 365 days when a third-party resource exists or the provider is out of state, and the prior authorization number has to be on it.9 Waiting for an authorization does not move the stale date. A claim held while another payer decided can still be paid if it reaches Nevada Medicaid within 60 days of that payer's payment or denial, with the EOB, and within two years of the last date of service. Appeals of denied claims go through the Provider Portal within 30 days of the first remittance advice that lists the denial, and adjustments to paid claims are due inside the stale date period. Gainwell Technologies is the fiscal agent that handles enrollment, billing and claims questions.
Medicare home health and hospice in Nevada
National Government Services, the A/B MAC for Jurisdiction 6, processes Medicare home health and hospice claims for Nevada, along with Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, New Jersey, New York, the Northern Mariana Islands, Oregon, Puerto Rico, the US Virgin Islands, Wisconsin and Washington.11 For Medicaid, MSM Chapter 1400 requires the agency to be enrolled as a Medicare certified home health agency licensed under state and federal law, to bill a third-party payer first when Medicaid is not primary, and to work from a physician's Plan of Care on a CMS 485 that the physician reviews every 60 days. Home health prior authorization requests go to the QIO-like vendor two days before the start of care, and the vendor states the exact number of services approved.
Common rejections in Nevada, and the fix
Personal care claim with no prior authorization number
The fixMSM Chapter 3500 pays nothing that the QIO-like vendor did not prior authorize, and MSM Chapter 100 requires the number on the claim. The biller matches each claim line to the authorization number, the authorized units and the date span before release.
Personal care units with no matching EVV visit
The fixPersonal care is payable only when it is documented in an approved EVV system, Sandata or the agency's own. The biller compares the visit export with the claim before it goes out and sends any missing or unverified visit back to the scheduler for correction first.
Claim received after the 180-day stale date
The fixThe fiscal agent denies it, and a late authorization is no excuse. The biller files as soon as visits are verified, logs the eligibility decision date for retroactive cases, and keeps the third-party documentation that supports the 365-day window or the 60-day window after another payer's EOB.
Gap between personal care authorizations at the annual update
The fixThe current authorization expired before the reassessment was done. The biller tracks every expiration date and prompts the agency to submit Form FA-24 60 to 90 days ahead, so the new prior authorization number is issued before the old one ends.
Waiver units billed above the Plan of Care
The fixThe units on the person-centered Plan of Care are the most the fiscal agent pays unless the case manager approves a temporary increase. The biller totals delivered units against the plan as visits are verified and asks the case manager for the change before the extra hours are delivered.
Home health visits beyond the approved number
The fixThe QIO-like vendor states the exact number of services approved and issues a Notice of Decision when it approves fewer. The biller tracks visits against that count and asks the agency to request more before the next visit, keeping the Plan of Care on the CMS 485 current.
Waiver client's claim sent to a health plan
The fixMSM Chapter 3600 keeps 1915(c) waiver enrollees and the aged, blind and disabled category out of managed care, so the plan rejects it. The biller reads the eligibility response for a plan before billing and sends waiver clients' claims to the fiscal agent.
Remitwright serves Nevada home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from Nevada agencies
Do we bill a health plan or the fiscal agent for people on a Nevada waiver?
How are our personal care hours authorized in Nevada, and how do we get them changed?
Can we keep our own EVV system instead of Sandata?
How long do we have to file a Nevada Medicaid home care claim?
Can a family member be paid to give care that our agency bills?
What does Nevada Medicaid need before our first home health visit?
Which programs pay for home care in Nevada?
Which services fall under EVV in Nevada?
Which Medicare contractor pays home health and hospice claims in Nevada?
What do you need from us to start billing for our Nevada agency?
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