Nevada Medicaid and Nevada Check Up News (Fourth 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]

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NOTIFICATION:The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, January 26, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

Multi-Factor Authentication Frequently Asked Questions

Unwinding COVID-19 Information

Known System Issues-Click HERE

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 December 2024 Professional Claims. See Web Announcement 3538.

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

Top Prior Authorization Denial Reasons for the Third Quarter of 2024. See Web Announcement 3488.

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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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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201. web_announcement_368_20101203.pdf
... beginning Jan. 1, 2011, but may start the process immediately if they choose to do so. The re-enrollment requirement does not apply to providers who enrolled ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_368_20101203.pdf
202. SR-61_20110921.pdf
... NV 89520-3042. To locate form FA-41 on the Magellan Medicaid Administration web site, choose the “Providerâ€drop -down menu, then select the †...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SR-61_20110921.pdf
203. NV_BillingGuidelines_PT56_20111111.pdf
... a recipient is enrolled in a Managed least) 30-day increments and Care Organization (MCO), request prior ï ‚ Provide a weekly summary of the authorization from ...
Terms matched: 1  -  Score: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56_20111111.pdf
204. NV_BillingGuidelines_PT11_online_062112.pdf
... 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: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_062112.pdf
205. NV_BillingGuidelines_PT56_20100623.pdf
... in a Managed per diem rate. General rate information is on Care Organization (MCO), request prior the DHCFP website at http://dhcfp.nv.gov. ...
Terms matched: 1  -  Score: 35  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56_20100623.pdf
206. Training_FrequentlyAskedQuestions.pdf
... How does EVS notify me that a recipient is in a Managed Care Organization (MCO)? If a recipient is enrolled in an MCO, the detail may ...
Terms matched: 1  -  Score: 150  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Training_FrequentlyAskedQuestions.pdf
207. web_announcement_1022_20151201.pdf
... associated with the National Provider Identifier (NPI) will be displayed and you can choose to revalidate or update. This will take you to the Online Provider Enrollment ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1022_20151201.pdf
208. NV_BillingGuidelines_PT43_20111205.pdf
... the EPSDT program. Managed care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20111205.pdf
209. Web_Portal_QRG_20120110_Old.pdf
... Administrator (must match step 12 above) . person to register. 14) Choose a Site Key (use left or right arrows to ï ‚ The System ...
Terms matched: 1  -  Score: 61  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Web_Portal_QRG_20120110_Old.pdf
210. web_announcement_413_20110926.pdf
... 19 at the Cashman Center located at 850 Las Vegas Boulevard N. Providers may choose to attend a morning or an afternoon conference in either Reno or Las Vegas ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_413_20110926.pdf
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