Nevada Medicaid and Nevada Check Up News (Third 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, December 7, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • 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)
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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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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1. FA-11E-I.pdf
... columns. See the example below showing the modifier on the first line and the second line blank. FA-11E Instructions Page 3 of 4 11/26/2025 ...
Terms matched: 1  -  Score: 20  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E-I.pdf
2. Known_Issues.pdf
... - First dose) and 0072A- (Pfizer-BioNTech Covid-19 Pediatric Vaccine - Administration - Second dose) are denying incorrectly with error code 3337-(Non-Cov Proc Due ...
Terms matched: 1  -  Score: 37  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... . 242 SECONDARY DIAGNOSIS CODE INVALID 1148 Second Diagnosis Code is invalid. 146 Diagnosis ...
Terms matched: 2  -  Score: 161  -  04 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. Benefit_Enrollment_and_Maintenance_(834).pdf
... 2000 and 2300 loops will contain an “024â€maintenance code. The second occurrence of the 2000 and 2300 loops will contain an “021†...
Terms matched: 1  -  Score: 77  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
5. NV_Billing_General_20250801.pdf
... . If a concurrent authorization request is not received within this time frame, a second authorization period, if clinically appropriate, can begin on the date Nevada Medicaid ...
Terms matched: 1  -  Score: 30  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
6. NV_Billing_General.pdf
... . If a concurrent authorization request is not received within this time frame, a second authorization period, if clinically appropriate, can begin on the date Nevada Medicaid ...
Terms matched: 1  -  Score: 30  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_EVS_User_Manual_Ch1.pdf
... *) . 3 4 39 4. Click Continue. 5. On the second Registration page, enter a User ID and Password. • Your ...
Terms matched: 1  -  Score: 33  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
8. NV_BillingGuidelines_PT26_20220318.pdf
... bill using the U1 modifier to determine the first starting month, U2 for the second month, U3 for the third month and U4 for the fourth month. ...
Terms matched: 1  -  Score: 20  -  13 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20220318.pdf
9. web_announcement_Volume 22 Issue 3_20250930.pdf
... Forms Updates User Guide for instructions. 3 Top Prior Authorization Denial Reasons for the Second Quarter of 2025 Complete Anonymous 4 Professional Claim Denial Rate Review Survey Reasons and ...
Terms matched: 1  -  Score: 46  -  30 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2022%20Issue%203_20250930.pdf
10. web_announcement_3712_20250904.pdf
... Medicaid Web Announcement 3712 Attention All Providers: Top Prior Authorization Denial Reasons for the Second Quarter of 2025 Nevada Medicaid and its fiscal agent have reviewed all prior authorization ...
Terms matched: 1  -  Score: 52  -  04 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3712_20250904.pdf
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