Nevada Medicaid and Nevada Check Up News (First 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. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 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 March 2026 Professional Claims. See Web Announcement 3894.

    Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

    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  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT87_Spec250_090324.pdf
... Best Practices to Operate Crisis Receiving and Stabilization Services • Essential Principles for Modern Crisis Care Systems: o Addressing Recovery Needs 09/03/2024 Provider ...
Terms matched: 1  -  Score: 20  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250_090324.pdf
3. NV_Billing_General_20260101.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
4. NV_Billing_General.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 31  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
5. NV_Billing_General_20251017.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
6. NV_Billing_General_20251215.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
7. NV_BillingGuidelines_PT33_20250623.pdf
... submitted in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards. • For HCPCS code descriptions that identify multiple components, ...
Terms matched: 1  -  Score: 13  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
8. NV_BillingGuidelines_PT33.pdf
... submitted in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards. • For HCPCS code descriptions that identify multiple components, ...
Terms matched: 1  -  Score: 13  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
9. web_announcement_3753_20251024.pdf
... employment solutions: Not âœ" âœ" available 844-396-2329 GED, HISet tests, industry certification, money for work clothes; $100 gym ChooseAnthem.com/nv membership ...
Terms matched: 1  -  Score: 14  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
10. Benefit_Enrollment_and_Maintenance_(834).pdf
... of Council for Affordable Quality Healthcare, CORE is a committee of more than 100 industry leaders who help create and promulgate a set of voluntary business rules focused on ...
Terms matched: 1  -  Score: 31  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
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