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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... Portal. Managed Care claims will be accepted by the applicable Managed Care Organization (MCO) and may be submitted on paper or electronically. Providers should access EVS ...
Terms matched: 1  -  Score: 35  -  16 Aug 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/COVID-19_Dental_Billing_Guide.pdf
... in a Managed • Revenue code 0123: NF Pediatric Care Organization (MCO) upon Specialty Care I or NF Pediatric admission, that MCO is responsible ...
Terms matched: 1  -  Score: 35  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19_20090325.pdf
... qualified health care professionals. She commented that they believe prescribers should be permitted to choose the most appropriate agent without prior authorization (PA) as it can worsen ...
Terms matched: 1  -  Score: 34  -  22 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_March_2022.pdf
... . Page 2 FALL 2006 Nevada Medicaid News DHCFP Awards New Managed Care Organization (MCO) Contracts The Division of Health Care Financing If you ha ve any que ...
Terms matched: 1  -  Score: 33  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v3i4.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 32  -  10 Nov 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_Dec_2020.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 32  -  17 Dec 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_Jan_2021_.pdf
... 2020. • Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. 2020[b ] . www.uptodate.com/ . Accessed ...
Terms matched: 1  -  Score: 32  -  15 May 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_June_2020.pdf
... Fee-For-Service (FFS) 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: 31  -  06 May 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_031424.pdf
... Service (FFS) 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: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_070314.pdf
... Fee-For-Service (FFS) 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: 31  -  27 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_062618.pdf
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