Nevada Medicaid and Nevada Check Up News (Second 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. to midnight Pacific Time on Sunday, October 25, 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)
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for September 2026 Professional Claims. See Web Announcement 4031.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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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Scheduled Site Maintenance

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
8:00PM - 12:00AM

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1. EVS_FAQ.pdf
... provider/Home/tabid/135/Default.aspx PWP? When my enrollment is No. Providers are required to create their own PWP account. approved by Nevada ...
Terms matched: 1  -  Score: 78  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS_FAQ.pdf
2. MFA_FAQ.pdf
... also help minimize the risk of security breaches. Is enrolling in MFA optional? No. Who is required to use MFA? Everyone accessing the PWP, Provider ...
Terms matched: 1  -  Score: 42  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/MFA_FAQ.pdf
3. PT29_PA_FAQ.pdf
... home, and skilled psychiatric nursing services. Each recipient has different care needs and no two recipients will be authorized the same exact number of units for home health ...
Terms matched: 1  -  Score: 20  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT29_PA_FAQ.pdf
4. NV_Billing_General.pdf
... : If your appeal is rejected (e.g. for incomplete information) there is no extension to the original 30 calendar days 03/10/2009 This update ...
Terms matched: 1  -  Score: 184  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
5. NV_Billing_General_20261008.pdf
... : If your appeal is rejected (e.g. for incomplete information) there is no extension to the original 30 calendar days 03/10/2009 This update ...
Terms matched: 1  -  Score: 184  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
6. NV_BillingGuidelines_PT22.pdf
... to the expenditure limits, include emergency, dentures and palliative care. There is no adult benefit coverage for endodontics or non-emergency extractions. For more information on services ...
Terms matched: 1  -  Score: 46  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
7. NV_BillingGuidelines_PT22_20260701.pdf
... to the expenditure limits, include emergency, dentures and palliative care. There is no adult benefit coverage for endodontics or non-emergency extractions. For more information on services ...
Terms matched: 1  -  Score: 46  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20260701.pdf
8. OPR_FAQs.pdf
... with Nevada Medicaid. Do I also need to enroll as an OPR provider? No. Providers already enrolled as active Medicaid participating providers do not need to enroll ...
Terms matched: 1  -  Score: 39  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/OPR_FAQs.pdf
9. NV_EnrollmentChecklist_PT63_Spec715.pdf
... by a multidisciplinary team under the oversight of a licensed mental health professional? Yes No Does this RRMHC/CRMHS facility have sufficient staff to provide clinical assessments, ...
Terms matched: 1  -  Score: 62  -  20 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT63_Spec715.pdf
10. NV_EVS_User_Manual_Ch4.pdf
... date going forward, by either the requesting or servicing provider. If there are no authorizations to view, you will see the following page. 3 If there ...
Terms matched: 1  -  Score: 58  -  20 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
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