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
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1. NV_BillingGuidelines_PT22-attachmentA.pdf
... tooth $1 ,000 Limitation for Adults 21 years and older D2940 DENTAL SEDATIVE FILLING 00 00 00 2 units per 6 months per tooth D2950 CORE BUILD-UP INCL ...
Terms matched: 1  -  Score: 26  -  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
... STEEL CROWN 00 02 02 1 unit per 36 months per tooth D2940 DENTAL SEDATIVE FILLING 00 00 00 2 units per 6 months per tooth D2950 CORE BUILD-UP INCL ...
Terms matched: 1  -  Score: 25  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
3. NV_BillingGuidelines_PT22.pdf
... expenditure limit per calendar year: diagnostic; preventive; periodontal; and operative (fillings and crowns) . Additional benefits for Medicaid-eligible adults age 21 and older, ...
Terms matched: 1  -  Score: 16  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
4. NV_BillingGuidelines_PT60_2026-0429.pdf
... month a QMHA. per recipient Note: This service must be preceded by a filled medication prescription within 30 days. Diagnostic 96138 Psychological or neuropsychological test administration and ...
Terms matched: 1  -  Score: 48  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
5. NV_BillingGuidelines_PT60.pdf
... month a QMHA. per recipient Note: This service must be preceded by a filled medication prescription within 30 days. Diagnostic 96138 Psychological or neuropsychological test administration and ...
Terms matched: 1  -  Score: 48  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
6. PT_34_Therapy_Tip_Sheet.pdf
... Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) ... page of the new FA-7 is completely filled out Other Forms FA-6: Unscheduled Revisions ...
Terms matched: 2  -  Score: 55  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... . 376 4TH OTHER ICD PROCEDURE DATE 1305 The 4th Other ICD Procedure date is ... REQUIRED - HDR 339 Interpreter's Statement Not Filled in 251 The attachment/other documentation ...
Terms matched: 2  -  Score: 42  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. NV_BillingGuidelines_PT60_2025-1216.pdf
... month a QMHA. per recipient Note: This service must be preceded by a filled medication prescription within 30 days. Diagnostic 96138 Psychological or neuropsychological test administration and ...
Terms matched: 1  -  Score: 48  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
9. NV_BillingGuidelines_PT65.pdf
... uniformity of the Hospice Program. All fields on the forms are required to be filled in and the physician signature must be included. Nevada Medicaid Hospice forms without ...
Terms matched: 1  -  Score: 20  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65.pdf
10. NV_BillingGuidelines_PT65_online_20230126.pdf
... uniformity of the Hospice Program. All fields on the forms are required to be filled in and the physician signature must be included. Nevada Medicaid Hospice forms without ...
Terms matched: 1  -  Score: 20  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65_online_20230126.pdf
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