Nevada Medicaid and Nevada Check Up News (Second 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]

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NOTIFICATION:The following Nevada Medicaid Provider Web Portal services will be unavailable from 7 p.m. to midnight Pacific Time Sunday, July 20, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
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    • Provider Claim Appeals
    • Prior Authorization (PA) system
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  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

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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.

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391. web_announcement_2640_20211201.pdf
... Care Organizations (MCOs) . This change takes effect with the new Nevada Medicaid MCO contracts that begin January 1, 2022. The Division of Health Care Financing ...
Terms matched: 1  -  Score: 36  -  01 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2640_20211201.pdf
392. NV_BillingGuidelines_PT29_online_20191125.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: 36  -  01 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20191125.pdf
393. NV_BillingGuidelines_PT29_online_20210526.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: 36  -  10 Apr 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20210526.pdf
394. NV_BillingGuidelines_PT29_online_20240411.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: 36  -  18 Mar 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20240411.pdf
395. NV_BillingGuidelines_PT29_online_20250318.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: 36  -  09 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20250318.pdf
396. web_announcement_208_090308.pdf
... bill the additional charges at the rates listed on the applicable Managed Care Organization (MCO) or Medicaid Fee For Service (FFS) fee schedules. For example ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_208_090308.pdf
397. NV_Medicaid_News_2022-1013.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
398. PASRR_PWP_QRG.pdf
... to the PASRR application: 1) Click on your Admin tab. 2) Choose “Show Users for Name of Organizationâ€for Organization Profile. PASRR ...
Terms matched: 1  -  Score: 36  -  25 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PASRR_PWP_QRG.pdf
399. 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  -  04 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2022-1230.pdf
400. NV_Billing_General_chapter6.pdf
... of one or more prior authorization requests. Transaction 820: Premium payment for enrolled MCO recipients. ï ‚ Transaction 834: Recipient enrollment/disenrollment to an MCO ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_chapter6.pdf
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