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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... January 1, 2018, to serve recipients enrolled in a Managed Care Organization (MCO) in urban Washoe and urban Clark counties. As of July 1, ...
Terms matched: 1  -  Score: 38  -  11 Sep 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1442_20170911.pdf
... information documented in the Fee-for- Service (FFS) or Managed Care Organization (MCO) policy and billing manuals. Nevada Medicaid consists of four different health care ...
Terms matched: 1  -  Score: 104  -  21 Sep 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1447_20170921.pdf
... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 35  -  22 Sep 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20151204.pdf
... 1, 2018, to serve Medicaid recipients enrolled in a Managed Care Organization (MCO) in urban Washoe and urban Clark counties. As of July 1, ...
Terms matched: 1  -  Score: 92  -  26 Oct 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2017-1026.pdf
... in Condition checkbox selected, along with a copy of the approved authorization from the MCO. This MCO documentation must include the service type (PCS), approved ...
Terms matched: 1  -  Score: 84  -  26 Oct 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1463_20171026.pdf
... authorized to access. â"€ Choose the Functions you want the delegate to ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for- Service (FFS ...
Terms matched: 2  -  Score: 65  -  31 Oct 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PWP_PA_Training_2017-07.pdf
... 31, 2017, dental services for recipients enrolled in a Managed Care Organization (MCO) in Washoe and Clark counties will continue to be managed through Fee-for- ...
Terms matched: 1  -  Score: 41  -  09 Dec 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1480_20171208.pdf
... Benefits Administrator (DBA) to serve recipients enrolled in a Managed Care Organization (MCO) in Washoe and Clark counties. ï ‚ The final day to request ...
Terms matched: 1  -  Score: 23  -  21 Dec 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1486_20171221.pdf
... Benefits Administrator (DBA) to serve recipients enrolled in a Managed Care Organization (MCO) in Washoe and Clark counties. In preparation for the contract start date ...
Terms matched: 1  -  Score: 21  -  28 Dec 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1489_20171228.pdf
... Web Portal www.medicaid.nv.gov Nevada Medicaid New Provider Orientation 18 Nevada Medicaid Managed Care Organizations (MCO) Nevada Medicaid Managed Care Organizations The DHCFP oversees the administration of all Nevada ...
Terms matched: 1  -  Score: 21  -  11 Jan 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/New_Provider_Orientation_011118.pdf
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