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]

Notifications

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.

Scheduled Site Maintenance

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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... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... 9999 Processed Per Policy 45 Charge exceeds fee schedule/maximum N130 Consult plan benefit ...
Terms matched: 2  -  Score: 153  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... ) for all qualified Medicaid visits and the payments the FQHC would have received for fee- for-service (FFS) Medicaid recipients receiving the same services. This concept ...
Terms matched: 1  -  Score: 94  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... ) for all qualified Medicaid visits and the payments the FQHC would have received for fee- for-service (FFS) Medicaid recipients receiving the same services. This concept ...
Terms matched: 1  -  Score: 41  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
... €menu) . Rates are available on the PWP at www.medicaid.nv.gov through the Search Fee Schedule function, which can be accessed on the PWP webpage under Resources ( ...
Terms matched: 1  -  Score: 36  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41.pdf
... ) . Rates are available on the Provider Web Portal at www.medicaid.nv.gov through the Search Fee Schedule function, which can be accessed on the Electronic Verification System Provider Login ...
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... €™s invoice may be required to substantiate payment by Medicaid per PT 33 fee schedule, and an unaltered complete order form specific to the manufacturer and model ...
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... .... 16 Termination of eligibility .... 16 Sample Medicaid card .... 16 Fee For Service vs. Managed Care .... 17 MCO contact information .... ...
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... eligibility .... 15 Termination of eligibility.... 15 Sample Medicaid card .... 15 Fee For Service vs. Managed Care .... 16 MCO contact information.... 17 ...
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... available on the Provider Web Portal at https://www.medicaid.nv.gov through the Search Fee Schedule function, which can be accessed on the Provider Login (PWP) ...
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