Nevada Medicaid: DXC Technology
Please follow the Enrollment Instructions below to become an electronic submitter for Nevada Medicaid.
Required Documents for those applying for new Submitter IDs
The following documents are required enrollment documents that must be completed, signed and returned to the FHSC office prior to initiation of electronic claims submission or inquiry.
1. FH-35 Electronic Transaction Agreement for Service Centers
2. FH-36 Service Center Operational Information
3. FH-37 Service Center Authorization Form for Providers
4. One Public SSH Key (we provide to you)
If the links above do not work properly, please download the forms from here:
If you have any questions regarding any of the documents in this package, please call the FHSC EDI Technology Support Center at 1-877-638-3472.
FH-35 Electronic Transaction Agreement for Service Centers
Section 1: Submitter Information
Enter your Business/Practice or Provider name
City, State, Zip
Section 2: Signature
Sign and Date the bottom of this form
FH-36 Service Center Operational Information
Section 1: General
Please select “I am enrolling with Nevada Medicaid (DXC Technology) as a Service Center for the first time”
Section 2: Contact Information
Please enter your Business/Practice or Provider name
Phone and Fax numbers
Name and Email of the main Contact person for your office
Section 3: Electronic Transaction Types
Remittance Advice (835) – To receive your EOBs electronically in ClaimShuttle
Professional (837 P) – For CMS 1500 claims
Institutional (837 I) – For UB04 claims
Please call us for IP address and ports
Section 5: Software Vendor Information
Please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information
FH-37 Service Center Authorization Form for Providers
NOTE: This form must be filled out for EACH Provider Medicaid Number that will be submitting electronic claims.
Check the Box that says “I will submit claims directly from my business to Nevada Medicaid (DXC Technology) (direct submitter)”
Enter your Business/Practice or Provider Name. Leave the SC Code field blank
Please select the following transactions to Authorize that apply to your needs:
Professional claim – CMS 1500 claims
Institutional claim – UB04 claims
Remittance Advice – Remittance Advice
Claim Status Request/Response (276/277)
Do not fill out the next section below about “Terminating a Transaction”
Enter Practice or Provider name
Enter Provider’s NPI and Tax ID
Check the appropriate response
Enter Authorized Signature
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:
PO Box 30042
Reno, Nevada 89520-3042
It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.
Waiting for a Response
Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)
After processing, a confirmation will be email to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the EDI Technology Support Center at 1-877-638-3472.
Once you have received your Submitter ID and Password from Medicaid, please call the ClaimShuttle Support Team. We will need to assign you a SSH Key and set an appointment for a Mailbox setup and Test Transmission.
Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.