Nevada Medicaid and Nevada Check Up News (Third 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 Sunday, November 23, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • 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)

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.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
... Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 28  -  04 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
3. Incretin_Mimetics_2013-0812.pdf
... Incretin Mimetics 2013 0812 ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Incretin_Mimetics_2013-0812.pdf
4. Immunomodulators_2015-0812.pdf
... Immunomodulators 2015 0812 ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2015-0812.pdf
5. Immunomodulators_2013-0812.pdf
... Immunomodulators 2013 0812 ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2013-0812.pdf
6. HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
... JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, ... HMG CoA Reductase Inhibitors 2013 0812 ...
Terms matched: 2  -  Score: 22  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
7. HMG CoA Reductase Inhibitors.pdf
... 3 ): 427-37. 104. Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, et al. Effect ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG%20CoA%20Reductase%20Inhibitors.pdf
8. Hepatitis_C_Protease_Inhibitors_2013-0812.pdf
... Hepatitis C Protease Inhibitors 2013 0812 ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Hepatitis_C_Protease_Inhibitors_2013-0812.pdf
9. Hepatitis_C_Antivirals_2013-0812.pdf
... Hepatitis C Antivirals 2013 0812 ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Hepatitis_C_Antivirals_2013-0812.pdf
10. Growth_Hormone_2013-0812.pdf
... Growth Hormone 2013 0812 ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Growth_Hormone_2013-0812.pdf
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