Nevada Medicaid and Nevada Check Up News (First 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]


Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Please be advised that claims must be submitted before noon Pacific Time on Fridays to be included in the following weeks’ remittance advice.

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

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 March 2024 Professional Claims. See Web Announcement 3335.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023. See Web Announcement 3280.

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 and the Billing Guide for your provider type at

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

8:00PM - 12:00AM

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... . 14 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 39  -  07 Jun 2022  -  URL:
... Residential Habilitation Services) for recipients that were covered in a Managed Care Organization (MCO) adjudicated incorrectly. The following impacted claims have been reprocessed automatically. â ...
Terms matched: 1  -  Score: 21  -  07 Jun 2022  -  URL:
... has had a rheumatology consultation, including the date of the visit: ____ Choose one of the following: The recipient has had RA for < six months ...
Terms matched: 1  -  Score: 21  -  06 Jun 2022  -  URL:
... 2020 35 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 192  -  23 May 2022  -  URL:
... Service Call Center telephone number above. Please use this script to assist you in choosing the appropriate options. Thank you for calling Nevada Medicaid. To ensure quality ...
Terms matched: 1  -  Score: 23  -  23 May 2022  -  URL:
... systems are not required for the providers to respond to the data request if they choose to do so. A small number of respondents expressed privacy concerns regarding information ...
Terms matched: 1  -  Score: 12  -  12 May 2022  -  URL:
... submitted in writing. You may submit comments in one of two ways (please choose only one of the ways listed): Electronically: You may email comments ...
Terms matched: 1  -  Score: 16  -  10 May 2022  -  URL:
... Home Companion X X ANGEL’S TOUCH HOME CARE LLC X Anthem (MCO) X X Apex EDI X X X Availity, LLC X X X ...
Terms matched: 1  -  Score: 96  -  02 May 2022  -  URL:
... 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  -  06 Apr 2022  -  URL:
... DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on the appropriate agenda, will be presented at the quarterly ...
Terms matched: 1  -  Score: 127  -  04 Apr 2022  -  URL:
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