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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... the appropriate Neva- Covered by HMO da Medicaid HMO/Managed Care Organization (MCO) for Plan processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 35  -  31 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2020%20Issue%201_20230331.pdf
... menu) . Managed Care Hospitals may provide services to Medicaid Managed Care Organization (MCO) recipients but must request reimbursement from the MCO. There are no carve-outs ...
Terms matched: 1  -  Score: 36  -  30 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20090801.pdf
... for Nevada Medicaid FFS recipients. Below are the dates and times from which to choose: Date Time Registration link Tuesday, June 13, 2023 8 a.m. ...
Terms matched: 1  -  Score: 20  -  30 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3041_20230330.pdf
... 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  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20220202.pdf
... claim to the by HMO Plan appropriate Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the recipient belongs to ...
Terms matched: 1  -  Score: 36  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3023_20230302.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: 129  -  06 Feb 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NCPDP_Encounter_Companion_Guide.pdf
... services. Nevada Check Up recipients are not disenrolled from a Managed Care Organization (MCO) when they receive hospice services. Although Nevada Check Up recipients receiving hospice ...
Terms matched: 1  -  Score: 64  -  26 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65_online_20210421.pdf
... services. Nevada Check Up recipients are not disenrolled from a Managed Care Organization (MCO) when they receive hospice services. Although Nevada Check Up recipients receiving hospice ...
Terms matched: 1  -  Score: 64  -  26 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65.pdf
... Options This section describes the connectivity options from which a Trading Partner will need to choose for the submission of transactions. Nevada Medicaid supports multiple methods for exchanging electronic ...
Terms matched: 1  -  Score: 68  -  20 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EDI_Trading_Partner_User_Guide.pdf
... claim to the by HMO Plan appropriate Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the recipient belongs to ...
Terms matched: 1  -  Score: 36  -  20 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2985_20230120.pdf
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