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
... Rule for Procedure) on the Web Portal until this issue has been resolved. 50 Claims, Provider The Provider Type 44 Billing Guidelines informs • Provider ...
Terms matched: 1  -  Score: 34  -  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 ... : 05/05/2026 Page 50 of 185 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 108  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT60_2025-1216.pdf
... Provider Type(s ) 90846 Family psychotherapy (without the patient present), 50 minutes. • 50 minutes All Levels QMHP, LCSW, â ...
Terms matched: 1  -  Score: 55  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
4. NV_BillingGuidelines_PT60.pdf
... Provider Type(s ) 90846 Family psychotherapy (without the patient present), 50 minutes. • 50 minutes All Levels QMHP, LCSW, â ...
Terms matched: 1  -  Score: 55  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
5. Provider_Enrollment_Information_Booklet.pdf
... that the bed count is more than 16 Institution for Mental beds and more than 50% of care is primarily engaged in Disease (IMD) providing diagnosis, ...
Terms matched: 1  -  Score: 11  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic procedures, the ...
Terms matched: 1  -  Score: 14  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
7. NV_BillingGuidelines_PT20-24-77.pdf
... applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic procedures, the ...
Terms matched: 1  -  Score: 14  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
8. NV_Billing_General.pdf
... Updated 02/20/2026 Billing Manual Pv01/01/2026 36 o 50 â€" Claim Adjustment Non-Check Related o 51 â€" Adjustments â ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. NV_Billing_General_20260101.pdf
... Updated 01/01/2026 Billing Manual Pv12/15/2025 36 o 50 â€" Claim Adjustment Non-Check Related o 51 â€" Adjustments â ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
10. NV_EVS_User_Manual_Ch1.pdf
... delegate, Trading Partner or MCO .... 48 1.8.1. Inactive Delegate Accounts ... 50 1.8.2. Switching providers as a delegate ... 51 1.9. Forgot user ID ...
Terms matched: 1  -  Score: 32  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
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