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. Error_Code_to_EOB_to_ANSI.pdf
... Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 28  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT11_online_082725.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
3. NV_BillingGuidelines_PT11.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
4. NV_BillingGuidelines_PT60_2025-1216.pdf
... health care professional. • Limit of 1 unit per 6 months D9410 House/extended care facility call. D9420 Hospital or ambulatory surgical center call. ...
Terms matched: 1  -  Score: 10  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
5. NV_BillingGuidelines_PT60.pdf
... health care professional. • Limit of 1 unit per 6 months D9410 House/extended care facility call. D9420 Hospital or ambulatory surgical center call. ...
Terms matched: 1  -  Score: 10  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
6. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... A MEDICAL HEALTH 00 00 00 1 unit per 6 months CARE PROFESSIONAL D9410 DENTAL HOUSE CALL 00 00 00 D9420 HOSPITAL CALL 00 00 00 D9440 OFFICE VISIT AFTER ...
Terms matched: 1  -  Score: 12  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
7. NV_BillingGuidelines_PT22-attachmentA.pdf
... A MEDICAL HEALTH 00 00 00 1 unit per 6 months CARE PROFESSIONAL D9410 DENTAL HOUSE CALL 00 00 00 D9420 HOSPITAL CALL 00 00 00 D9440 OFFICE VISIT AFTER ...
Terms matched: 1  -  Score: 12  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
8. NV_BillingGuidelines_PT87_Spec250_090324.pdf
... Coordinate connection to ongoing care. CSC case management services will assist patients to obtain housing, food, primary health care and other basic needs along with the coordination ...
Terms matched: 1  -  Score: 20  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250_090324.pdf
9. NV_Billing_General.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 31  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
10. NV_Billing_General_20260101.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 22  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
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