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]

Notifications


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.

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

Monday
8:00PM - 12:00AM

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70 results found containing all search terms. 729 results found containing some search terms.

80 pages of results.
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 222  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Professional_837P_MCO_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 63  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter_NET_837P_Companion_Guide_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 210  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Institutional_837I_MCO_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 228  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Dental_837D_MCO_Mod_n061818.pdf
... (P value not reported) . When permitted to years of age with attacks choose between eletriptan and sumatriptan SC for subsequent treatment, 78% of vs migraine ...
Terms matched: 1  -  Score: 26  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/5-HT1%20Receptor%20Agonists_2015-1002.pdf
... ) • Those receiving Targeted Case Management (TCM) • MCO enrollees • Nevada Check-Up enrollees (CHIP) • Emergency ...
Terms matched: 1  -  Score: 23  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/6_Health_Care_Guidance_Program_2014.pdf
... Expanded Call Center 2014 Annual Medicaid Conference 2015 Open Enrollment • Clients who choose to use the pre-screener and are determined potentially eligible for a Qualified Health Plan ...
Terms matched: 1  -  Score: 36  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/3_Division_of_Welfare_DWSS_2014.pdf
... • Advanced Practice Registered Nurses • Physician Forums with FFS and MCO • Prior Authorization Alignment between FFS and MCO • Health ...
Terms matched: 1  -  Score: 57  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2_Medicaid_Program_Highlights_DHCFP_2014.pdf
... remain on the line and make a note of the verification number. NOTE: MCO Eligibility and eligibility verification number are provided at the end of the call. ...
Terms matched: 1  -  Score: 116  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/201306_Verifying_Eligibility.pdf
... 6386 VLBW 179 189 184 169 Rate 2.34% 2.48% 2.73% 2.65% MCO Live Births 6671 7955 8963 8363 VLBW 70 86 110 100 Rate 1.05% ...
Terms matched: 1  -  Score: 26  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2013_Care_Management.pdf
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