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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... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  22 Dec 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2965_20221222.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.pdf
... scheduled for following month after the recipient has transitioned to a Managed Care Organization (MCO) . Commencing with date of service June 1, 2005, we will ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_50_041805.pdf
... be When a recipient is enrolled in a Managed documented in the Care Organization (MCO), request PA recipient's medical from and submit claims to the MCO. ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_20111111.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  25 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2929_20221025.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  13 Sep 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2894_20220913.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  -  30 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46_20190131.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  -  23 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46_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  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46_20150929.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  -  13 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2019%20Issue%203_20221013.pdf
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