Nevada Medicaid and Nevada Check Up News (Fourth 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]

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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, March 22, 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)

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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
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1. 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  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. 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  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. 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  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. NV_Billing_General_20260101.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  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
5. NV_EVS_User_Manual_Ch1.pdf
... receive a code. 7. Enter the code you receive in the Enter code box. Click Verify. 8. You will return to the login page. ...
Terms matched: 1  -  Score: 113  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
6. NV_Flex_User_Guide_Getting_Started.pdf
... . 3. Select “Provider Enrollment.â€4. Click the top blue box to access Provider Flex. Updated 02/18/2026 Page 2 of ...
Terms matched: 1  -  Score: 51  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
7. NV_EVS_User_Manual_Ch3.pdf
... €" If the recipient has other insurance that paid as primary, check this box; When this box is checked the Other Insurance Information panel will appear on ...
Terms matched: 1  -  Score: 126  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
8. NV_EnrollmentChecklist_PT93_Spec704.pdf
... National Provider Identifier (NPI): ____ Please check one of the following boxes. Updates to Clinical Supervisors of the agency are reported using this form and ...
Terms matched: 1  -  Score: 41  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
9. NV_Billing_General_20251215.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  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
10. NV_Billing_General_20251017.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  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
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