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
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... : 03/09/2026 Page 50 of 180 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 108  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. 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  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. 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
4. 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
5. 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
6. 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  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
7. NV_EVS_User_Manual_Ch3.pdf
... asterisk (* ) are required fields. Service Details • Up to 50 service details to be added to a dental claim • Procedure codes ...
Terms matched: 1  -  Score: 63  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
8. NV_BillingGuidelines_PT14_online_011226.pdf
... . the Intensity of LMFT, LCPC Needs grid. 90846 Family Psychotherapy (without 50 minutes; bill one QMHP, The services must deal with issues relating Yes ...
Terms matched: 1  -  Score: 23  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
9. NV_BillingGuidelines_PT14.pdf
... integration/reintegration of the patient to exceed into the family. service limits. 50 minutes; bill one unit per day 90847 Family Psychotherapy (with See Outpatient ...
Terms matched: 1  -  Score: 23  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
10. NV_EnrollmentChecklist_PT93_Spec704.pdf
... and dated, that the bed count is more than 16 beds and more than 50% of care is primarily engaged in providing diagnosis, treatment or care of ...
Terms matched: 1  -  Score: 21  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
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