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:
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  • 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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1. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... : 03/09/2026 Page 100 of 180 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 49  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT17_Spec181.pdf
... Medicaid website at https://www.nevadamedicaid.nv.gov/ . • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types ...
Terms matched: 1  -  Score: 23  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
3. NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... Nevada Medicaid website at http://dhcfp.nv.gov. • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types ...
Terms matched: 1  -  Score: 23  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... also published on the following website at https://dhcfp.nv.gov. MSM Chapter 100 contains specific enrollment requirements. General Information Enrollment requirements vary depending on provider type ...
Terms matched: 1  -  Score: 85  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. NV_Billing_General.pdf
... forth in the Medicaid Services Manual (see Medicaid Services Manual (MSM) Chapter 100 Medicaid Program and MSM Chapter 3300 Program Integrity) • Obtaining prior ...
Terms matched: 1  -  Score: 98  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
6. NV_Billing_General_20260101.pdf
... forth in the Medicaid Services Manual (see Medicaid Services Manual (MSM) Chapter 100 Medicaid Program and MSM Chapter 3300 Program Integrity) • Obtaining prior ...
Terms matched: 1  -  Score: 98  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
7. NV_BillingGuidelines_PT85_Spec320.pdf
... ¢ MSM Chapter 400 covers policy for Behavioral Health providers • MSM Chapter 100 contains important information applicable to all provider types, including information regarding medical necessity ...
Terms matched: 1  -  Score: 21  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
8. Known_Issues.pdf
... rule) and 4871-(Claim type restriction on proc billing table) . 100 Claims, Some Provider Type 22-(Dentist) are being †...
Terms matched: 1  -  Score: 11  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
9. NV_EVS_User_Manual_Ch3.pdf
... to the original 30 calendar days. Per Medicaid Services Manual (MSM) Chapter 100, Section 105.2C titled Disputed Payment, appeal requests for subsequent same service claim ...
Terms matched: 1  -  Score: 12  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
10. NV_BillingGuidelines_PT14.pdf
... MSM Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed ...
Terms matched: 1  -  Score: 14  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
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