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, July 26, 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 June 2026 Professional Claims. See Web Announcement 3964.

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.

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

Monday
8:00PM - 12:00AM

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1. NV_BillingGuidelines_PT22-attachmentA.pdf
... D7290 REPOSITIONING OF TEETH 00 NC NC D7291 TRANSSEPTAL FIBEROTOMY 00 00 00 D7292 SCREW RETAINED PLATE 00 00 00 D7293 TEMP ANCHORAGE DEV W FLAP 00 00 00 D7294 ...
Terms matched: 1  -  Score: 58  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
... D7290 REPOSITIONING OF TEETH 00 NC NC D7291 TRANSSEPTAL FIBEROTOMY 00 00 00 D7292 SCREW RETAINED PLATE 00 00 00 D7293 TEMP ANCHORAGE DEV W FLAP 00 00 00 D7294 ...
Terms matched: 1  -  Score: 58  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
3. NV_BillingGuidelines_PT34_2026-0101.pdf
... an aerosol generator, nebulizer, metered dose inhaler or IPPB device 94667 Manipulation chest wall, such as cupping, percussing, Required and vibration to facilitate lung function ...
Terms matched: 1  -  Score: 24  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2026-0101.pdf
4. NV_BillingGuidelines_PT34.pdf
... an aerosol generator, nebulizer, metered dose inhaler or IPPB device 94667 Manipulation chest wall, such as cupping, percussing, Required and vibration to facilitate lung function ...
Terms matched: 1  -  Score: 24  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
5. NV_BillingGuidelines_PT60_2026-0429.pdf
... teeth or tooth bounded spaces per quadrant. D4263 Bone replacement graft â€" retained natural tooth - first site in quadrant. • Limit of 4 ...
Terms matched: 1  -  Score: 21  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
6. NV_BillingGuidelines_PT60.pdf
... teeth or tooth bounded spaces per quadrant. D4263 Bone replacement graft â€" retained natural tooth - first site in quadrant. • Limit of 4 ...
Terms matched: 1  -  Score: 21  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
8. Known_Issues.pdf
... Medicare before billing Medicaid. Complete the Medicare payment information fields on the claim and retain a copy of explanation of benefits) . The provider type and specialties listed ...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
9. Error_Code_to_EOB_to_ANSI.pdf
... . 376 4TH OTHER ICD PROCEDURE DATE 1305 The 4th Other ICD Procedure date is ... payment information fields on the claim and retain a copy of the explanation of benefits ...
Terms matched: 2  -  Score: 42  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
10. NV_BillingGuidelines_PT60_2025-1216.pdf
... teeth or tooth bounded spaces per quadrant. D4263 Bone replacement graft â€" retained natural tooth - first site in quadrant. • Limit of 4 ...
Terms matched: 1  -  Score: 21  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
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