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]

Notifications


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

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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... menu) . Managed Care Hospitals may provide services to Medicaid Managed Care Organization (MCO) recipients but must request reimbursement from the MCO. There are no carve-outs ...
Terms matched: 1  -  Score: 36  -  30 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20090801.pdf
... menu) . Managed Care Hospitals may provide services to Medicaid Managed Care Organization (MCO) recipients but must request reimbursement from the MCO. There are no carve-outs ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20100701.pdf
... versus Fee For Service 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: 36  -  25 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20150929.pdf
... versus Fee For Service 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: 36  -  25 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20170724.pdf
... versus Fee For Service 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: 36  -  15 Nov 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20190125.pdf
... coverage period. Rather, at any time during the 180-day coverage period, an MCO may assess whether a recipient can be discharged to a lower level of care ...
Terms matched: 1  -  Score: 36  -  22 Feb 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3285_20240222.pdf
... Expanded Call Center 2014 Annual Medicaid Conference 2015 Open Enrollment • Clients who choose to use the pre-screener and are determined potentially eligible for a Qualified Health Plan ...
Terms matched: 1  -  Score: 36  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/3_Division_of_Welfare_DWSS_2014.pdf
... 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  -  18 May 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3078_20230518.pdf
... ¢ Fee-For-Service 837P - Professional Health Care Claim Companion Guide • Encounter-Institutional 837I MCO Companion Guide • Encounter-Professional 837P MCO Companion Guide Billing POS 340B claims ...
Terms matched: 1  -  Score: 36  -  12 Jun 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3374_20240612.pdf
... 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  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3023_20230302.pdf
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