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
... Nursing Facilities must have at least one payable accommodation revenue code on the claim. 80 Claims, Dental Some dental claims are being denied incorrectly • Provider ...
Terms matched: 1  -  Score: 23  -  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 ... 319 Diagnosis not allowed for abortion CPTs 80 PROCEDURE CODE NOT PAYABLE WITH 11 The ...
Terms matched: 2  -  Score: 65  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_EnrollmentChecklist_PT14_Flex.pdf
... 5:00 p.m. Pacific Time Monday through Friday. Please check the applicable box for each section below and provide service address information. Upload the completed checklist ...
Terms matched: 1  -  Score: 64  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Flex.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... current This is the location where services are rendered and cannot be a post office box, gated community, or virtual address . Each service address for an organization ...
Terms matched: 1  -  Score: 10  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. FA-30-I.pdf
... by clicking in any field and typing. You can check and uncheck the check boxes by clicking them. Completing the Form The following sections describe the information to ...
Terms matched: 1  -  Score: 82  -  16 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30-I.pdf
6. FA-30.pdf
... Reason for seeking out-of-state placement (this section must be complete; more than one box can be checked) Exit Seeking/Flight Risk Behavior Wandering Behavior Violent Behavior ...
Terms matched: 1  -  Score: 23  -  16 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30.pdf
7. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... service as D7320 for the same quadrant. D7410 RAD EXC LESION UP TO 1.25 CM 00 NC NC D7411 EXCISION BENIGN LESION>1.25C 00 NC NC D7412 EXCISION ...
Terms matched: 1  -  Score: 66  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
8. NV_BillingGuidelines_PT22-attachmentA.pdf
... service as D7320 for the same quadrant. D7410 RAD EXC LESION UP TO 1.25 CM 00 NC NC D7411 EXCISION BENIGN LESION>1.25C 00 NC NC D7412 EXCISION ...
Terms matched: 1  -  Score: 66  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
9. NV_Billing_General.pdf
... : Nevada Medicaid Dental PA P.O. Box 30042 Reno NV 89520-3042 Personal Care Services ... • NCPDP: Batch Standard 1.2 EDI resources The following documents are provided ...
Terms matched: 2  -  Score: 55  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
10. NV_Billing_General_20260101.pdf
... : Nevada Medicaid Dental PA P.O. Box 30042 Reno NV 89520-3042 Personal Care Services ... • NCPDP: Batch Standard 1.2 EDI resources The following documents are provided ...
Terms matched: 2  -  Score: 55  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
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