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
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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1. Known_Issues.pdf
... January 1, 2026, some Medicaid eligible needed. members were incorrectly switched from Fee For • Once resolved, claims will be Service (FFS) ...
Terms matched: 1  -  Score: 120  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... 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  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT11_online_082725.pdf
... @dhcfp.nv.gov requesting assistance, along with the supporting documentation. Managed Care vs. Fee For Service (FFS) When a recipient is enrolled in a Managed Care ...
Terms matched: 1  -  Score: 43  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
4. NV_BillingGuidelines_PT11.pdf
... ™s District Office at CareCoordination@nvha.nv.gov for assistance. Managed Care vs. Fee For Service (FFS) When a recipient is enrolled in a Managed Care ...
Terms matched: 1  -  Score: 43  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
5. NV_BillingGuidelines_PT60_2025-1216.pdf
... . Prior Authorization SHS do not require prior authorization. See the Provider Type 60 Fee Schedule for a list of available procedure codes. Third Party Liability (TPL ...
Terms matched: 1  -  Score: 91  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
6. NV_BillingGuidelines_PT60.pdf
... . Prior Authorization SHS do not require prior authorization. See the Provider Type 60 Fee Schedule for a list of available procedure codes. Third Party Liability (TPL ...
Terms matched: 1  -  Score: 91  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. NV_BillingGuidelines_PT20-24-77.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 Provider Web Portal (PWP ...
Terms matched: 1  -  Score: 64  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
8. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.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 Provider Web Portal (PWP ...
Terms matched: 1  -  Score: 64  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
9. NV_BillingGuidelines_PT43.pdf
... nurse practitioner. The following list of covered services is provided for your convenience. Fee schedules are located on the Nevada Medicaid Rate Setting webpage at https:/ ...
Terms matched: 1  -  Score: 159  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
10. NV_BillingGuidelines_PT43_20251118.pdf
... nurse practitioner. The following list of covered services is provided for your convenience. Fee schedules are located on the Nevada Medicaid Rate Setting webpage at http:/ ...
Terms matched: 1  -  Score: 131  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20251118.pdf
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