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
12:00AM - 12:30AM

8:00PM - 12:00AM

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

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... for no prior authorization due to a change in eligibility from Managed Care Organization (MCO) to Fee-for-Service (FFS) after a newborn’s date of ...
Terms matched: 1  -  Score: 56  -  15 Jun 2017  -  URL:
... in a Managed per diem rate. General rate information is on Care Organization (MCO), request prior the DHCFP website at ...
Terms matched: 1  -  Score: 35  -  15 Jun 2017  -  URL:
... . A 30-day override period started October 29, 2014, when the pharmacist may choose to override a denied claim for OPR. Pharmacies will receive the following message ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL:
... links: one for employers of BST providers and one for BST providers; please choose the appropriate link to be taken to the survey. Please provide any additional ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL:
... not require prior authorization. For Managed support, non-emergency transport claim Care Organization (MCO) enrollees, check A0429 Ambulance service, basic life 1 unit per with ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL:
... bill the additional charges at the rates listed on the applicable Managed Care Organization (MCO) or Medicaid Fee For Service (FFS) fee schedules. For example ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL:
... orders, prescriptions or referrals for individuals enrolled in a Medicaid Managed Care Organization (MCO) . It is applicable only to the Nevada Fee for Service (FFS ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL:
... date for the exiting agency. Recipients who request a transfer but require assistance to choose a new agency will be directed to their local Nevada Medicaid District Office for ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL:
... be a 30- day override period starting October 29, when the pharmacist may choose to override a denied claim for OPR. If a claim hits the soft ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL:
... article on this page) . Benefits of EDI vary according to which option you choose. Benefits of EDI typically include: • Faster reimbursement: First ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL:
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