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. FA-11.pdf
... . FA-11 Page 1 of 4 Updated 04/09/2026 (pv12/15/2025) Nevada Medicaid and Nevada Check Up Behavioral Health Outpatient or Rehabilitative ...
Terms matched: 1  -  Score: 73  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. Known_Issues.pdf
... Skilled Training and • Claims will be adjusted to pay the Development, 15 minutes) were paying an correct rate. incorrect rate. 12 Claim & ...
Terms matched: 1  -  Score: 232  -  06 May 2026  -  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 ... : 05/05/2026 Page 15 of 185 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 55  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... period. For example, if the current authorization period is 05/11/15 through 05/15/15, then the concurrent authorization request is due ...
Terms matched: 1  -  Score: 56  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. NV_BillingGuidelines_PT11.pdf
... period. For example, if the current authorization period is 05/11/15 through 05/15/15, then the concurrent authorization request is due ...
Terms matched: 1  -  Score: 56  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
6. NV_BillingGuidelines_PT60.pdf
... For codes that specify a time segment in their description, e.g., each 15 minutes or each 30 minutes, each of these timed segments equals one unit ...
Terms matched: 1  -  Score: 547  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. NV_BillingGuidelines_PT60_2025-1216.pdf
... For codes that specify a time segment in their description, e.g., each 15 minutes or each 30 minutes, each of these timed segments equals one unit ...
Terms matched: 1  -  Score: 547  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
8. Provider_Enrollment_Information_Booklet.pdf
... 2: Application Types .... 14 Advance Directives and Civil Rights Compliance .... 15 Provider Groups Allowing Linkage .... 15 Table 3: Group Provider Enrollment Allowable ...
Terms matched: 1  -  Score: 133  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
9. NV_BillingGuidelines_PT20-24-77.pdf
... for more information. Medical Nutrition Therapy Medical Nutrition Therapy services are reimbursable under PT 15 (Registered Dietitian) . Please refer to the PT 15 Billing Guide for ...
Terms matched: 1  -  Score: 33  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
10. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... for more information. Medical Nutrition Therapy Medical Nutrition Therapy services are reimbursable under PT 15 (Registered Dietitian) . Please refer to the PT 15 Billing Guide for ...
Terms matched: 1  -  Score: 33  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
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