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. Known_Issues.pdf
... 20/2019 7/29/2019 8/9 /2019 Professional (Frames, purchases), V2107-(Spherocylinder, • Once resolved ...
Terms matched: 1  -  Score: 11  -  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 ... similar procedure within set CARE COORDINATOR time frame. 3353 SPECIALIZED FOSTER CARE CHECKLIST 3352 ...
Terms matched: 2  -  Score: 309  -  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
... the pertinent information in the synopsis. Authorization requests must be received within the time frames listed below. • Prior authorization must be obtained before non-emergent inpatient ...
Terms matched: 1  -  Score: 62  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
4. NV_BillingGuidelines_PT11.pdf
... the pertinent information in the synopsis. Authorization requests must be received within the time frames listed below. • Prior authorization must be obtained before non-emergent inpatient ...
Terms matched: 1  -  Score: 62  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
5. NV_BillingGuidelines_PT60_2025-1216.pdf
... field analyzer full threshold programs 30-2, 24-2, or 30/60-2) V2020 Frames, purchases. • Encounter = 1 unit • Limit ...
Terms matched: 1  -  Score: 10  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
6. NV_BillingGuidelines_PT60.pdf
... field analyzer full threshold programs 30-2, 24-2, or 30/60-2) V2020 Frames, purchases. • Encounter = 1 unit • Limit ...
Terms matched: 1  -  Score: 10  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. web_announcement_3891_20260410.pdf
... Chapter 100 and the Billing Manual for information concerning the claim appeal process and time frames. Update: EVV claims that denied correctly with other error codes will not ...
Terms matched: 1  -  Score: 20  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3891_20260410.pdf
8. NV_BillingGuidelines_PT25-41_20241218.pdf
... ¢ Ocular prosthesis • Vision therapy • Qualifying eyeglass lenses and frames with a prescription • Polycarbonate lenses See MSM Chapter 1100 on the ...
Terms matched: 1  -  Score: 108  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41_20241218.pdf
9. NV_BillingGuidelines_PT25-41.pdf
... ¢ Ocular prosthesis • Vision therapy • Qualifying eyeglass lenses and frames with a prescription • Polycarbonate lenses See MSM Chapter 1100 on the ...
Terms matched: 1  -  Score: 108  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41.pdf
10. NV_Billing_General_20260101.pdf
... revisions; added prior authorization appeals mailing address 07/01/2015 Retroeligibility time frame changed from five days to ten days; 22 and 23 updated instructions under ...
Terms matched: 1  -  Score: 99  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
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