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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... 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
... – ª Self directed providers disabilities) $175 billion â – ª Providers that choose to accept funds must attest to the terms and conditions in payments to be ...
Terms matched: 1  -  Score: 41  -  14 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Relief_Fund_Step-by-Step_Provider_Guide.pdf
... Announcement 704 6 Quarterly Provider Training Ordering, Prescribing and Referring 7 Quarterly Provider Training MCO and FFS • This new requirement does not apply to orders, ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Quarterly_Provider_Training_Presentation_FINAL_2014-0328.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_20140801.pdf
... Data (Subscriber Information 2100 C Loop) An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 41  -  29 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Premium_Payment_(820).pdf
... urban Washoe counties will no longer be managed by the current Managed Care Organizations (MCO) . As of July 1, 2017, dental services and claims will ...
Terms matched: 1  -  Score: 41  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1404_20170630.pdf
... Fee-For-Service • When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. â ...
Terms matched: 1  -  Score: 41  -  29 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT21.pdf
... authorization Fee-for-Service emergency transport does not require prior authorization. For Managed Care Organization (MCO) enrollees, check with the MCO for special requirements. Covered services The ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_20140416.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  -  09 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20191226.pdf
... enrolled in a Managed Care exclusions, coordination of benefits and other terms Organization (MCO), request prior authorization and conditions set forth by the benefit program. ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_070110.pdf
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