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 May 2024 Professional Claims. See Web Announcement 3382.

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
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66 results found containing all search terms. 691 results found containing some search terms.

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... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 47  -  15 Jun 2017  -  URL:
... (UAC), which will be online July 2, 2007, providers will choose their own Delegated Administrator who will create users and grant users appropriate access to ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL:
... is transitioned to a Managed Care Effective with dates of service on or Organization (MCO) at the beginning of after July 1, 2009, for Nevada Check ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL:
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the first month of admission ...
Terms matched: 1  -  Score: 112  -  15 Jun 2017  -  URL:
... A recipient diagnosed with SED or SMI chooses to disenroll from the TCM services do ... in areas where Managed Care Organization (MCO) enrollment is mandatory, may disenroll ...
Terms matched: 2  -  Score: 98  -  15 Jun 2017  -  URL:
... . Fee for Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. For ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL:
... Organizations (â €œMCOsâ€) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 24  -  15 Jun 2017  -  URL:
... PDL inclusion based on AB384. In addition, the P&T Committee may choose to exempt any drug class they feel is not appropriate for PDL inclusion. ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL:
... White Pine, Lander, Eureka, Humboldt, Pershing and Churchill. Recipients who choose self-directed services will be assisted by a Financial Management Service staff and a Support ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL:
... - January, February and March viduals enrolled in a Medicaid Managed Care Organization (MCO) . It is applica- 2013. Nearly 100 percent of ble only ...
Terms matched: 1  -  Score: 14  -  15 Jun 2017  -  URL:
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