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_EnrollmentChecklist_PT63_Spec715.pdf
... ? _____ What gender does your facility treat? Female Male Please check the box for each specialty your facility treats: Asperger’s or Autism Attention ...
Terms matched: 1  -  Score: 20  -  20 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT63_Spec715.pdf
2. NV_EVS_User_Manual_Ch4.pdf
... a referring provider, complete one of the following options: 1. Check the box to indicate - Referring Provider same as Requesting Provider OR 2. Use the ...
Terms matched: 1  -  Score: 69  -  20 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... current This is the location where services are rendered and cannot be a post office box, gated community, or virtual address . Each service address for an organization ...
Terms matched: 1  -  Score: 10  -  19 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. NV_Billing_General_20260710.pdf
... authorizations Phone: (800) 525-2395 Mail: Nevada Medicaid Dental PA P.O. Box 30042 Reno NV 89520-3042 Personal Care Services (PCS) authorizations Phone: ( ...
Terms matched: 1  -  Score: 51  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
5. NV_Billing_General.pdf
... authorizations Phone: (800) 525-2395 Mail: Nevada Medicaid Dental PA P.O. Box 30042 Reno NV 89520-3042 Personal Care Services (PCS) authorizations Phone: ( ...
Terms matched: 1  -  Score: 51  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
6. Error_Code_to_EOB_to_ANSI.pdf
... Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 28  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
7. web_announcement_3999_20260908.pdf
... Case Criteria section of Form FA-15 must be completed and either the first or second box must be checked. Member is under 9 years old: Member is 9 ...
Terms matched: 1  -  Score: 55  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3999_20260908.pdf
8. FA-15.pdf
... discuss any behaviors leading up to the need for the PRN medication in the related boxes below for justification for continued services, critical incidents, restraints, etc. ...
Terms matched: 1  -  Score: 20  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-15.pdf
9. NV_EVS_User_Manual_Ch2.pdf
... at: Mailing Address: HMS â€" NV Third Party Liability P.O. Box 12610 Reno, NV 89510 Phone: (775) 335-1040; Toll Free ...
Terms matched: 1  -  Score: 20  -  25 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch2.pdf
10. NCPDP_Encounter_Companion_Guide.pdf
... the Gainwell Technologies Contact Center for Providers. For written correspondence: Nevada Medicaid PO Box 30042 Reno, Nevada 89520-3042 9.3 Applicable Websites/Email This section contains detailed ...
Terms matched: 1  -  Score: 11  -  15 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NCPDP_Encounter_Companion_Guide.pdf
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