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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... ; November 2017. • Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate website. www.uptodate.com. Updated November 9, 2019. ...
Terms matched: 1  -  Score: 10  -  05 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anticonvulsants_2021-04.pdf
... to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation: ï ‚ 0 = would never ...
Terms matched: 1  -  Score: 10  -  05 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Narcolepsy_Agents_2021-04.pdf
... public for in-person services** If you are in a Managed Care Plan (MCO) â€" Please call your plan at: Anthem Blue Cross and ...
Terms matched: 1  -  Score: 83  -  03 Feb 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/COVID_Flyers.pdf
... “Formsâ€page, locate the “Hospice Formsâ€section and choose appropriate forms. †' Make sure that all instructions are followed. ...
Terms matched: 1  -  Score: 88  -  19 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Hospice_Provider_Training_2021.pdf
... Presentation Presented to NV DUR Board on January 28, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 57  -  06 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Jan_2021.pdf
... Home Companion X X ANGEL’S TOUCH HOME CARE LLC X Anthem (MCO) X X Apex EDI X X X Availity, LLC X X X ...
Terms matched: 1  -  Score: 96  -  06 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Trading%2520Partners%2520Fully%2520Certified%2520Report.pdf
... ; November 2017. • Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate website. www.uptodate.com. Updated November 9, 2019. ...
Terms matched: 1  -  Score: 11  -  05 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_Jan_2021.pdf
... DUR Reports  23 Anticonvulsants, Misc. Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 76  -  04 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_Jan_2021.pdf
... Drug Use Review Board Meeting JANUARY 28, 2021 2021 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 60  -  04 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_Jan_2021.pdf
... denied or fewer days. If you choose to request fewer days than were originally ... member of a Managed Care Organization (MCO) . - The QIO-like vendor will ...
Terms matched: 2  -  Score: 79  -  04 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_63_RTC_Training_2020.pdf
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