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]

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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.

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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. Error_Code_to_EOB_to_ANSI.pdf
... MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are ... /09/2026 Page 10 of 180 Claim Error ... /09/2026 Page 15 of 180 Claim Error ...
Terms matched: 3  -  Score: 566  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... 02 Telehealth provided in a location other than in a recipient’s home 10 Telehealth provided in a recipient’s home Modifiers Description 93 Synchronous audio ...
Terms matched: 1  -  Score: 20  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... and Specialties Outpatient Surgery, Hospital Based 10 Specialty type code: • ... Directives and Civil Rights Compliance .... 15 Provider Groups Allowing Linkage .... 15 ...
Terms matched: 2  -  Score: 216  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. FA-1D.pdf
... during the wheelchair evaluation. Include previous repairs and dates of service of repairs. 10. Itemize all parts requiring replacement and their cost in the table on page ...
Terms matched: 1  -  Score: 20  -  23 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-1D.pdf
5. NV_Billing_General_20260101.pdf
... the original 30 calendar days 03/10/2009 This update included the removal ... 01/2026 Billing Manual Pv12/15/2025 i Date (mm/ ...
Terms matched: 2  -  Score: 524  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
6. NV_Billing_General.pdf
... the original 30 calendar days 03/10/2009 This update included the removal ... information document Updates made throughout 12/15/2025 Updated title of Medicaid Services ...
Terms matched: 2  -  Score: 218  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_EVS_User_Manual_Ch1.pdf
... shown below. Then click OK. 10 8. Enter contact information including a ... 13 1.5. Provider information .... 15 1.6. Updating provider profile .... ...
Terms matched: 2  -  Score: 233  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
8. NV_Flex_User_Guide_Getting_Started.pdf
... Updated 02/18/2026 Page 10 of 45 pv09/02/2025 ... 1.3. Forgot User ID .... 15 1.4. Forgot Password .... 16 ...
Terms matched: 2  -  Score: 35  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
9. NV_BillingGuidelines_PT85_Spec320.pdf
... shown below, at the detail-level of the claim. T1016 U1 Comprehensive Care Management 15 minutes T1016 U2 Care Coordination 15 minutes T1016 U3 Comprehensive Transitional Care 15 minutes ...
Terms matched: 1  -  Score: 91  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
10. Known_Issues.pdf
... €¢ Provider: No additional action 10/03/2025 12/15 ... 2025 TBD Authorization equivalent to the allowed quantity submitted on the claim; needed. ...
Terms matched: 2  -  Score: 612  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
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