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 Sunday, October 25, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • Provider Flex
  • Gabby®, which includes:
    • Gainwell Technologies Contact Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • 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)

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_Billing_General.pdf
... /2019 Updates made throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) 03/18/2019 Updates made throughout All sections 11 ...
Terms matched: 1  -  Score: 270  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
2. NV_Billing_General_20261008.pdf
... /2019 Updates made throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) 03/18/2019 Updates made throughout All sections 11 ...
Terms matched: 1  -  Score: 270  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
3. NV_BillingGuidelines_PT22.pdf
... Medicaid Fee for Services (FFS) recipients are billed through the FFS benefit delivery system. Benefit coverage, with limitations and prior authorization requirements can be found on ...
Terms matched: 1  -  Score: 74  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
4. NV_BillingGuidelines_PT22_20260701.pdf
... Medicaid Fee for Services (FFS) recipients are billed through the FFS benefit delivery system. Benefit coverage, with limitations and prior authorization requirements can be found on ...
Terms matched: 1  -  Score: 74  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20260701.pdf
5. OPR_FAQs.pdf
... . Please note that the requirement extends to pharmacy Point of Sale (POS) systems as well. The POS system will deny, at the time of the ...
Terms matched: 1  -  Score: 77  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/OPR_FAQs.pdf
6. NV_BillingGuidelines_PT32_Spec_249_online_20260727.pdf
... HCPCS Codes The allowable Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to be billed for Community Paramedicine services are available on ...
Terms matched: 1  -  Score: 21  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_249_online_20260727.pdf
7. NV_BillingGuidelines_PT32_Spec_249.pdf
... HCPCS Codes The allowable Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to be billed for Community Paramedicine services are available on ...
Terms matched: 1  -  Score: 20  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_249.pdf
8. NV_EVS_User_Manual_Ch4.pdf
... : Child and Adolescent Screening Intensity Instrument (CASII), Level of Care Utilization System (LOCUS), and Early Childhood Service Intensity Instrument (ECSII) . ...
Terms matched: 1  -  Score: 25  -  20 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
9. Provider_Enrollment_Information_Booklet.pdf
... : Chore Services (EVV Required) • 202: Personal Emergency Response System (PERS) • 208: Adult Companion Service (EVV Required ...
Terms matched: 1  -  Score: 89  -  19 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
10. NV_BillingGuidelines_PT85_20260727.pdf
... and a review of current coding practices.â€Nevada’s Medicaid Management Information System (MMIS) uses NCCI Edits in the processing of Nevada Medicaid claims. ...
Terms matched: 1  -  Score: 13  -  13 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_20260727.pdf
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