NVHA Claim Submission Updates Coming 4/1/2026

We have an important message regarding your claim submissions and changes that are coming.

As you know, Sandata, in partnership with Optum, has been providing a claims workflow that includes Optum issued EVV IDs and Connect Center Access for all NVHA providers. EVV IDs are used on claims submission whether you use the Sandata EVV State Sponsored billing solution or your own Alternate EVV and billing solution.

The Optum solution and associated IDs are being phased out and replaced with direct submission to your respective payers. This will happen in a phased approach, with some payers making a change sooner than others. It is important to reference the information below on when these changes will occur and what your billing configurations need to be.

IMPORTANT -- If you are using the Sandata EVV sponsored tool, Sandata will make the required changes on your behalf and route your claims appropriately so there is no further action required on your part other than the awareness of what's changing and when for your monitoring purposes. You will continue to capture visits using the state-sponsored solution, Sandata EVV, and submit your claims as usual. Nothing changes for your caregivers in the field.

Note, once claims have been submitted directly and not through Optum, they will no longer be visible through Optum and your Connect Center. However, prior claims will be available to view.

If you are using an Alternate EVV vendor (3^rd Party Vendor) billing solution, you must work with your billing vendor to make these adjustments ahead of the deadlines listed below.

As always, you should remain focused on ensuring that all visits are in a Verified Status and follow all NVHA policies and guidelines for EVV visit data before submitting claims.

Changes will begin on April 1^st, 2026, with the following MCO. This means that as of this date, claims will no longer flow through Optum but instead flow directly to your respective payers. These claims will not be viewable through your Connect Center. If they are submitted with the Optum EVV IDs, they will be rejected:

• Silver Summit

The following MCOs will begin Claims Validation soon and you will be notified in advance:

• HPN UHC
• Molina
• Anthem
• Gainwell (State of Nevada)

If you are a provider using an alternate EVV vendor, you need to ensure your vendor receives the following Payer IDs and sets up your new billing workflows. The key dates are listed in the column labeled “Begin Date for Updated Workflow” and the new Payer Ids are listed under “New Claim Payer Id”:

Payer Name	EVV Payer (Visit Payer ID)	Current Claim Payer ID	New Claim Payer ID	Begin Date for updated workflow	Recommended/ Payer-preferred Claims Routing (validate w/ each MCO)
Gainwell (State of Nevada)	NVFFS	NVFFS	NVMED	TBD	Send Claims to Nevada Medicaid via Gainwell w/ Trading Partner Connection
Anthem	NVANT	NVANT	000265	TBD	Send Claims to Anthem via Availity
HPN UHC	NVHPN	NVHPN	76342	TBD	Send Claims to Nevada Health Plan Network Sierra Plan via Optum
Molina	NVMOL	NVMOL	MLNNV	TBD	Send Claims to Molina via Optum
Silver Summit	NVSIL	NVSIL	68069	4/1/2026	Send Claims to Silver Summit via Availity

Please note that the EVV Payer (Visit Payer ID) column above is not changing.

If you have any additional questions or concerns, please reach out to Customer Support at 833-545-0394 for state-sponsored EVV solutions or 833-545-0395 for Alternate EVV solutions.