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 ... REQUIRED - HDR 383 Length of Stay Cut Back by Date of Sterilization; 252 ...
Terms matched: 2  -  Score: 42  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... service. Exceptions are Medicare assignment (billing at the Medicare fee schedule), sliding fee schedules that are based on a recipient’s income, contracted ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
... service. Exceptions are Medicare assignment (billing at the Medicare fee schedule), sliding fee schedules that are based on a recipient’s income, contracted ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... 06/2023 02/21/2023 NA Inpatient) are being denied or cut back needed. inappropriately with error codes 5643-(3 Units †...
Terms matched: 1  -  Score: 11  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 Updated 02/02/2026 pv ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
... limit. Must be provided by licensed SLIDES PREPARED ELSEWHERE pathologist. Must use modifier ... TMJ RECONSTRUCTION 01 NC 01 D7860 TMJ CUTTING INTO JOINT 00 NC 00 D7865 TMJ ...
Terms matched: 2  -  Score: 60  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
... service. Exceptions are Medicare assignment (billing at the Medicare fee schedule), sliding fee schedules that are based on a recipient’s income, contracted ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
... service. Exceptions are Medicare assignment (billing at the Medicare fee schedule), sliding fee schedules that are based on a recipient’s income, contracted ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
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