Nevada Medicaid and Nevada Check Up News (First Quarter 2025 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]

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Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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.

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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.

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1. FA-16B.pdf
... ASSESSING THE RECIPIENT’S NEEDS. ASSESSMENT NEEDS MEDICATION/IV DELIVERY NEEDS Choose one: This is based on the severity of illness and the stability of ...
Terms matched: 1  -  Score: 174  -  20 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-16B.pdf
2. Provider_Enrollment_Information_Booklet.pdf
... form and proof of account information in the attachments panel. Managed Care Organization (MCO) Network Providers: • All MCO Network providers must be enrolled ...
Terms matched: 1  -  Score: 41  -  17 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. Benefit_Enrollment_and_Maintenance_(834).pdf
... are performed, then no enrollment file will be generated and made available to the MCO. Monthly Files • Monthly files include members which have a maintenance ...
Terms matched: 1  -  Score: 84  -  17 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
4. NV_Flex_User_Guide_Individual.pdf
... Filesâ€button. 2. Click the “Select Filesâ€button and choose a PDF to attach. • Attachments must be in PDF format ...
Terms matched: 1  -  Score: 12  -  12 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
5. Known_Issues.pdf
... 1 /2019 6/25/2019 Managed Care, Managed Care Organization (MCO), all details on NDC (National outpatient or outpatient cross-over claims are ...
Terms matched: 1  -  Score: 40  -  11 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
6. Error_Code_to_EOB_to_ANSI.pdf
... Identification Segment (loop 2110 Service Payment Information REF), if present. 3365 MCO PAID DATE IS INVALID 1644 MCO Paid Date is Invalid. 16 Claim/ ...
Terms matched: 1  -  Score: 22  -  09 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
7. NV_Flex_User_Guide_Group.pdf
... not link individuals are required to select “Biller and Performerâ€13. Choose the option that most closely describes the entity you are enrolling in. Group ...
Terms matched: 1  -  Score: 14  -  06 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
8. web_announcement_3644_20250530.pdf
... in place prior to accepting/admitting the recipient. A receiving hospital may also choose to submit their own authorization request prior to the transfer occurring. As an ...
Terms matched: 1  -  Score: 21  -  30 May 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3644_20250530.pdf
9. web_announcement_3643_20250527.pdf
... records electronically with the ability for the patient to send those records to anyone they choose. The new slide deck and training materials regarding compliance can be found at ...
Terms matched: 1  -  Score: 20  -  27 May 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3643_20250527.pdf
10. NV_BillingGuidelines_PT96.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request PA from and submit claims to the MCO. For recipients ...
Terms matched: 1  -  Score: 38  -  20 May 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT96.pdf
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