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. TPL_Frequently_Asked_Questions.pdf
... a provider contact if Providers will need to contact Nevada Medicaid’s TPL vendor: incorrect commercial TPL or Health Management Systems, Inc. (HMS) ...
Terms matched: 1  -  Score: 23  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/TPL_Frequently_Asked_Questions.pdf
2. NV_Billing_General.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 149  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
3. NV_Billing_General_20261008.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 149  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
4. NV_BillingGuidelines_PT22_20260701.pdf
... Card System: To implement a swipe card system, please contact a swipe card vendor directly. FFS Benefit Coverage, Limitations and $1 ,000 Annual Expenditure ...
Terms matched: 1  -  Score: 14  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20260701.pdf
5. NV_BillingGuidelines_PT22.pdf
... Card System: To implement a swipe card system, please contact a swipe card vendor directly. FFS Benefit Coverage, Limitations and $1 ,000 Annual Expenditure ...
Terms matched: 1  -  Score: 14  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... Provider. Gainwell Technologies is the current Quality Improvement Organization (QIO) -like vendor for the Nevada Medicaid and Nevada Check Up programs. State Policy Nevada Medicaid ...
Terms matched: 1  -  Score: 14  -  19 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_Billing_General_20260710.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 149  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
8. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... the PBM occurrence has been reached. vendor to correct provider information. 3032 TOOTH ...
Terms matched: 2  -  Score: 31  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
9. NV_BillingGuidelines_PT14_online_092126.pdf
... MSM Chapter 400. If you need further clarification, please contact the Medicaid QIO-like vendor. Qualified Provider Types as noted in the following table: 14/300 ...
Terms matched: 1  -  Score: 12  -  29 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_092126.pdf
10. NV_BillingGuidelines_PT14.pdf
... MSM Chapter 400. If you need further clarification, please contact the Medicaid QIO-like vendor. Qualified Provider Types as noted in the following table: 14/300 ...
Terms matched: 1  -  Score: 12  -  29 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
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