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. 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
2. Known_Issues.pdf
... ) when billed without a modifier: • A4624-(Tracheal suction tube) • A4628-(Oropharyngeal suction catheter) • ...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... Service Payment Information REF), if present. 376 4TH OTHER ICD PROCEDURE DATE 1305 The 4th Other ICD Procedure date is missing 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 24  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT33_20250623.pdf
... Total Parenteral Nutrition (TPN) • Enteral formulas administered via a feeding tube Prior authorization is always required when any DMEPOS item is provided in an institutional ...
Terms matched: 1  -  Score: 70  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
5. NV_BillingGuidelines_PT33.pdf
... Total Parenteral Nutrition (TPN) • Enteral formulas administered via a feeding tube Prior authorization is always required when any DMEPOS item is provided in an institutional ...
Terms matched: 1  -  Score: 70  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
6. FA-19.pdf
... of Request: Special Needs (please check all that apply) Central Line Feeding Tube (G , J, NG) Glucose Monitoring Insulin Coverage IV O2 Ostomy ...
Terms matched: 1  -  Score: 54  -  16 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-19.pdf
7. NV_Billing_Sterilization.pdf
... 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s ), with or without removal of ovary(s ) 58152 ...
Terms matched: 1  -  Score: 184  -  11 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Sterilization.pdf
8. NV_EnrollmentChecklist_PT33_Flex.pdf
... the box next to each medical supply/equipment you wish to provide: Enteral Tube Feeding Supplies Ostomy Supplies Other Equipment: (specify) Other Supplies: ( ...
Terms matched: 1  -  Score: 20  -  08 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT33_Flex.pdf
9. NV_BillingGuidelines_PT33_20240523.pdf
... Total Parenteral Nutrition (TPN) • Enteral formulas administered via a feeding tube Prior authorization is always required when any DMEPOS item is provided in an institutional ...
Terms matched: 1  -  Score: 70  -  23 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20240523.pdf
10. FA-16B.pdf
... condition(s ) . inhaler, rectal, NJ, NG, or G tube. Do not include nebulizer or over-the- ï Initial physical assessment per shift ...
Terms matched: 1  -  Score: 45  -  20 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-16B.pdf
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