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.

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1. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... ) . Usage: Do not use designation code. this code for claims attachment ...
Terms matched: 2  -  Score: 65  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. FA-91.pdf
... I will be changing Hospice providers. I understand that I may only change the designation of the particular hospice from which hospice care will be received once in each ...
Terms matched: 1  -  Score: 20  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-91.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... : Specialized Foster Care Crisis Services Specialty type codes: • 031: Designated Mobile Crisis Team (DMCT) • 032: Certified Community Behavioral ...
Terms matched: 1  -  Score: 43  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. NV_BillingGuidelines_PT87_Spec250_090324.pdf
... Crisis Stabilization Services are behavioral health services designed to: De-escalate or stabilize a behavioral ... Services • Essential Principles for Modern Crisis Care Systems: o Addressing Recovery ...
Terms matched: 2  -  Score: 69  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250_090324.pdf
5. NV_BillingGuidelines_PT87_Spec031_090324.pdf
... Type 87 Specialty 031 Billing Guide Crisis Services: Mobile Crisis Response Delivered By A Designated Mobile Crisis Team (DMCT) Overview On September 17, 2021, per ...
Terms matched: 1  -  Score: 159  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec031_090324.pdf
6. NV_BillingGuidelines_PT87_Spec032_090324.pdf
... : Certified Community Behavioral Health Center (CCBHC) Delivering Mobile Crisis Response as a Designated Mobile Crisis Team (DMCT) Attached to a CCBHC Overview On September 17 ...
Terms matched: 1  -  Score: 140  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec032_090324.pdf
7. NV_BillingGuidelines_PT87.pdf
... Provider Type (PT) 87 Crisis Services: Specialty # Specialty Name: 031 Designated Mobile Crisis Team (DMCT) Certified Community Behavioral Health Center (CCBHC) ...
Terms matched: 1  -  Score: 77  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87.pdf
8. NV_BillingGuidelines_PT17_Spec181.pdf
... by an FQHC, regardless of whether the FQHC is the recipient’s designated primary care provider. • MEDICAL services under Managed Care invoice using ...
Terms matched: 1  -  Score: 20  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
9. ABA_FAQ.pdf
... family training that takes place in both the home and office settings? You can designate the training location by using the appropriate Place of Service (POS) code ...
Terms matched: 1  -  Score: 20  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
10. NV_Billing_General_20260101.pdf
... 38, 40-41, 33 and ICN designations; updated requirements for the Claim Appeal ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 76  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
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