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 on Sunday, December 21, 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)
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

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 November 2025 Professional Claims. See Web Announcement 3789.

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.

Monday - Friday
12:00AM - 12:30AM

Monday
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1. Known_Issues.pdf
... ) and/or error code 1022-(Referring NPI required) when the ordering NPI is entered appropriately with the “DKâ€qualifier. 84 Claims ...
Terms matched: 1  -  Score: 47  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_BillingGuidelines_PT60_2024-0828.pdf
... 3 Incorrectly Billed Claims .... 3 Modifiers .... 3 Units .... 4 Ordering, Prescribing and Referring (OPR) Provider Requirements .... 4 Rates.... ...
Terms matched: 1  -  Score: 225  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
3. NV_BillingGuidelines_PT60.pdf
... .... 3 Incorrectly Billed Claims.... 3 Modifiers.... 3 Units .... 4 Ordering, Prescribing and Referring (OPR) Provider Requirements.... 4 Rates.... 5 ...
Terms matched: 1  -  Score: 225  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
4. NV_BillingGuidelines_PT33_20250623.pdf
... submitted only for the units that exceed the assigned limitation, not for the total order. For example, if a prescription for diapers is for 200 units, ...
Terms matched: 1  -  Score: 161  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
5. NV_BillingGuidelines_PT33.pdf
... submitted only for the units that exceed the assigned limitation, not for the total order. For example, if a prescription for diapers is for 200 units, ...
Terms matched: 1  -  Score: 161  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
6. NV_Billing_General.pdf
... with Medicaid to render urgent/emergency services. Providers who are enrolled as an Ordering, Prescribing or Referring (OPR) provider cannot bill for services rendered to ...
Terms matched: 1  -  Score: 35  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... . 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... REF), if present. 1062 ORDERING NPI REQUIRED 1062 Ordering NPI is required ...
Terms matched: 2  -  Score: 165  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. NV_Enrollment_AnnualAttestation_PT63.pdf
... letter L and is then followed by three digits and is numbered according to the order in which a facility was identified as a PRTF in their State. For ...
Terms matched: 1  -  Score: 20  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Enrollment_AnnualAttestation_PT63.pdf
9. New_Provider_Road_Map.pdf
... a new provider. It is recommended to attend the following courses in this suggested order to ensure you get the information and resources you need. Icon Virtual Instructor-Led ...
Terms matched: 1  -  Score: 26  -  21 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/New_Provider_Road_Map.pdf
10. NV_BillingGuidelines_PT43_20250804.pdf
... Chapter 800 for the specific criteria that must be met before the tests can be ordered. • CPT codes for biomarker testing for diagnosis, treatment, ...
Terms matched: 1  -  Score: 198  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
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