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

NOTIFICATION: Known Issue with Resubmitting Returned to Provider (RTP) Applications
This issue has been resolved, and the impacted applications have been placed in the appropriate status for review.

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 24, 72, 74, and 77:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from April 14, 2025 – April 21, 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 February 2025 Professional Claims. See Web Announcement 3593.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2024. See Web Announcement 3458.

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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... 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
... five (5 ) times to enroll and credential with each Managed Care Organization (MCO) and/or Dental Benefit Administrator (DBA) . Nevada Medicaid wants ...
Terms matched: 1  -  Score: 20  -  13 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2979_20230113.pdf
... Crisis Stabilization Center services there will be a carve-out for MCOs, meaning recipients with MCO coverage will be reimbursed through Fee-For-Service (FFS) . NRS 695C.194 reads the ...
Terms matched: 1  -  Score: 20  -  06 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2975_20230106.pdf
... accordance with 42 CFR Â 438.602(b ), this requirement will apply to MCO network providers who order, prescribe or refer services/supplies for individuals enrolled ...
Terms matched: 1  -  Score: 37  -  05 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/OPR_FAQs.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  -  05 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_021622.pdf
... 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: 36  -  04 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2022-1230.pdf
... 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: 36  -  30 Dec 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2019%20Issue%204_20221230.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  22 Dec 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2965_20221222.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  25 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2929_20221025.pdf
... ered by HMO Plan ate Nevada Medicaid HMO/Managed Care Organiza- tion (MCO) for processing. Provider may find out which MCO the recipient be- ...
Terms matched: 1  -  Score: 36  -  19 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2022-1013.pdf
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