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, January 25, 2026, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • 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)

EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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1. Known_Issues.pdf
... the following edits on the Web Portal: • 270-(Header Total Billed Amount Missing) • 508-(HDR Billed AMT Not ...
Terms matched: 1  -  Score: 28  -  22 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... determine payment for the unrelated endoscopy, the multiple surgery rules are applied. The total payment for the related endoscopies is considered one service and the unrelated endoscopy is ...
Terms matched: 1  -  Score: 14  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
3. NV_BillingGuidelines_PT20-24-77.pdf
... determine payment for the unrelated endoscopy, the multiple surgery rules are applied. The total payment for the related endoscopies is considered one service and the unrelated endoscopy is ...
Terms matched: 1  -  Score: 14  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
4. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... has M54 Missing/incomplete/invalid total charges. submission/billing error( ...
Terms matched: 2  -  Score: 230  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
5. NV_BillingGuidelines_PT22-attachmentA.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  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
6. NV_BillingGuidelines_PT34.pdf
... combination of occurrence- and time-based codes may be used but may not exceed a total of four units. • Other Instructions: Other important information regarding ...
Terms matched: 1  -  Score: 104  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
7. NV_BillingGuidelines_PT34_2023-1121.pdf
... combination of occurrence- and time-based codes may be used but may not exceed a total of four units. • Other Instructions: Other important information regarding ...
Terms matched: 1  -  Score: 94  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
8. NV_Billing_General.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. NV_Billing_General_20251215.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
10. NV_Billing_General_20251017.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
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