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. FA-11.pdf
... "Units per day" multiplied by "Days per Week" multiplied by the total number of weeks in the entire date span equals “Total Units.†...
Terms matched: 1  -  Score: 35  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. Known_Issues.pdf
... • 270-(Header Total Billed Amount Missing) • ... Provider: No additional action 03/25/2026 N/A TBD Professional ...
Terms matched: 2  -  Score: 277  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are ... Missing/incomplete/invalid total charges. submission/ ... /05/2026 Page 25 of 185 Claim Error ...
Terms matched: 3  -  Score: 262  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT60_2025-1216.pdf
... standardized tests and measures in addressing a total of 3 or more elements from any ... Type 60 Fee Schedule. Modifier Definition 25 Significant, separately identifiable evaluation and management ...
Terms matched: 2  -  Score: 172  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
5. NV_BillingGuidelines_PT60.pdf
... standardized tests and measures in addressing a total of 3 or more elements from any ... Type 60 Fee Schedule. Modifier Definition 25 Significant, separately identifiable evaluation and management ...
Terms matched: 2  -  Score: 172  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... *: Ordering, Prescribing, Referring (OPR) Optometrist Specialty type codes: 25 • 825: Optometrist Group • 925: Optometrist â ...
Terms matched: 1  -  Score: 195  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_BillingGuidelines_PT20-24-77.pdf
... multiple surgery rules are applied. The total payment for the related endoscopies is considered ... /M CPT codes. Use modifier 25 to indicate a separately identifiable service. ...
Terms matched: 2  -  Score: 35  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
8. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... multiple surgery rules are applied. The total payment for the related endoscopies is considered ... /M CPT codes. Use modifier 25 to indicate a separately identifiable service. ...
Terms matched: 2  -  Score: 35  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
9. NV_BillingGuidelines_PT43.pdf
... disorders: 81432 and 81433. Prior authorization is required. Updated: 03/25/2026 Provider Type 43 Billing Guide Pv11/18/2025 1/ ...
Terms matched: 1  -  Score: 100  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
10. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... D7945 BONE CUTTING BODY MANDIBLE 01 01 01 Once in a lifetime D7946 RECONSTRUCTION MAXILLA TOTAL 01 01 01 Once in a lifetime D7947 RECONSTRUCT MAXILLA SEGMENT 01 01 01 ...
Terms matched: 1  -  Score: 12  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
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