Nevada Medicaid and Nevada Check Up News (Second Quarter 2026 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 8 p.m. to midnight Pacific Time on Monday, November 2, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • Provider Flex
  • Real time CAQH/CORE EDI eligibility and claim verification

IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for September 2026 Professional Claims. See Web Announcement 4031.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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 https://NevadaMedicaid.nv.gov/ and the Billing Guide for your provider type at www.medicaid.nv.gov.

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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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1. NV_EVS_User_Manual_Ch9.pdf
... DME, Hospice, Indian Health Services (IHS) and Tribal Clinics, Peer Support, Psychologist, Special Clinics, Substance Use Treatment, and Vision, providers ...
Terms matched: 1  -  Score: 62  -  28 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch9.pdf
2. PASRR_LOC_NF_Training_2021.pdf
... appropriate Mental Illness interventions (received within past 2 years): â€" Supportive Living â€" Housing Intervention â€" Other â€" None ...
Terms matched: 1  -  Score: 62  -  27 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PASRR_LOC_NF_Training_2021.pdf
3. PT29_PA_FAQ.pdf
... are required to provide any recent hospital discharge summaries, and any other documentation to support the number of hours requested. e. For ongoing PDN authorizations, requests ...
Terms matched: 1  -  Score: 82  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT29_PA_FAQ.pdf
4. MFA_FAQ.pdf
... or mobile phone. (Must be a direct line.) What devices are supported? • For the mobile application, any device that can download ...
Terms matched: 1  -  Score: 68  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/MFA_FAQ.pdf
5. EVS_FAQ.pdf
... ? The Administrator of the The new Administrator should send an email to the EDI Support team at: account is no longer with our nvmmis.edisupport@gainwelltechnologies.com requesting an ...
Terms matched: 1  -  Score: 23  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS_FAQ.pdf
6. NV_Billing_General.pdf
... Providers should now call the customer service center with any ... //www.medicaid.nv.gov, to support Nevada Medicaid and Nevada ... information necessary to disclose the full extent of services ( ...
Terms matched: 3  -  Score: 262  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_Billing_General_20261008.pdf
... Providers should now call the customer service center with any ... //www.medicaid.nv.gov, to support Nevada Medicaid and Nevada ... information necessary to disclose the full extent of services ( ...
Terms matched: 3  -  Score: 262  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
8. NV_BillingGuidelines_PT22.pdf
... with the original/initial request that supports the level of care/services requested ... ) Program are eligible to receive the full range of dental care without authorization, ...
Terms matched: 2  -  Score: 47  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
9. NV_BillingGuidelines_PT22_20260701.pdf
... with the original/initial request that supports the level of care/services requested ... ) Program are eligible to receive the full range of dental care without authorization, ...
Terms matched: 2  -  Score: 47  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20260701.pdf
10. OPR_FAQs.pdf
... If a provider desires to bill Medicaid, he or she must enroll as a full participating Medicaid provider. 18. What if the provider is enrolled with another ...
Terms matched: 1  -  Score: 20  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/OPR_FAQs.pdf
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