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
... Provider: Use the Web Portal to validate 2/1 /2019 2/12/2019 N/A Check Error the eligibility for an National Provider Identifier ...
Terms matched: 1  -  Score: 386  -  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 ... : 05/05/2026 Page 12 of 185 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 294  -  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
... /2025 Provider Type 11 Billing Guide pv05/06/2025 Page 1 of 12 Provider Type 11 Billing Guide Hospital, Inpatient • Complete form FA-12 ...
Terms matched: 1  -  Score: 204  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
4. NV_BillingGuidelines_PT11.pdf
... /2026 Provider Type 11 Billing Guide pv08/27/2025 Page 1 of 12 Provider Type 11 Billing Guide Hospital, Inpatient • Complete form FA-12 ...
Terms matched: 1  -  Score: 204  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
5. NV_BillingGuidelines_PT60.pdf
... .... 77 Updated 04/29/2026 Provider Type 60 Billing Guide pv 12/16/2025 1 / 78 Provider Type 60 Billing Guide School Health ...
Terms matched: 1  -  Score: 515  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
6. NV_BillingGuidelines_PT60_2025-1216.pdf
... Optometry Services.... 74 Case Management Services .... 76 Telehealth .... 77 Updated 12/16/2025 Provider Type 60 Billing Guide pv 08/28/ ...
Terms matched: 1  -  Score: 515  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
7. web_announcement_3897_20260421.pdf
... a.m. to 11:00 a.m. Professional Enrollment Overview for Groups Tuesday May 12, 2026 1:00 p.m. to 2:30 p.m. New ...
Terms matched: 1  -  Score: 36  -  22 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3897_20260421.pdf
8. Provider_Enrollment_Information_Booklet.pdf
... Specialty type code: • 911: Hospital, Inpatient Hospital, Outpatient 12 Specialty type code: • 912: Hospital, Outpatient Psychiatric Hospital ...
Terms matched: 1  -  Score: 118  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
9. NV_BillingGuidelines_PT65_online_20230126.pdf
... submitted with FA-95 (the prior authorization request) . For extended hospice services past 12 months, FA-96 must be submitted with FA-95. See page 2 of this ...
Terms matched: 1  -  Score: 23  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65_online_20230126.pdf
10. NV_BillingGuidelines_PT65.pdf
... submitted with FA-95 (the prior authorization request) . For extended hospice services past 12 months, FA-96 must be submitted with FA-95. See page 2 of this ...
Terms matched: 1  -  Score: 23  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65.pdf
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