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.

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1. NV_BillingGuidelines_PT22.pdf
... ) providers are instructed to submit dental claims with tooth surface codes indicated in alphabetical order. Managed Care (LIBERTY Dental Plan) Recipients Dental services provided to Managed ...
Terms matched: 1  -  Score: 27  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
2. NV_BillingGuidelines_PT22_20230327.pdf
... ) providers are instructed to submit dental claims with tooth surface codes indicated in alphabetical order. Prior Authorization (PA) Except for services for ID Waiver recipients, ...
Terms matched: 1  -  Score: 27  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20230327.pdf
3. NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
... per 60 months D9210 DENT ANESTHESIA W/O SURGERY 00 00 00 D9212 TRIGEMINAL BLOCK ANESTHESIA 00 00 00 D9215 LOCAL ANESTHESIA 00 00 00 D9222 DEEP SEDAT/ ...
Terms matched: 1  -  Score: 12  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
4. NV_BillingGuidelines_PT22-attachmentA.pdf
... per 60 months D9210 DENT ANESTHESIA W/O SURGERY 00 00 00 D9212 TRIGEMINAL BLOCK ANESTHESIA 00 00 00 D9215 LOCAL ANESTHESIA 00 00 00 D9222 DEEP SEDAT/ ...
Terms matched: 1  -  Score: 12  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
5. NV_BillingGuidelines_PT17_Specialty_181_20260306.pdf
... is identified by billing one unit of the valid encounter code listed below. In order to identify the nature of the services rendered, the FQHC must also submit ...
Terms matched: 1  -  Score: 21  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260306.pdf
6. NV_BillingGuidelines_PT17_Spec181.pdf
... is identified by billing one unit of the valid encounter code listed below. In order to identify the nature of the services rendered, the FQHC must also submit ...
Terms matched: 1  -  Score: 21  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
7. NV_BillingGuidelines_PT34_2026-0101.pdf
... therapy services furnished in whole or in part by a physical therapist assistant) . Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 116  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2026-0101.pdf
8. NV_BillingGuidelines_PT34.pdf
... therapy services furnished in whole or in part by a physical therapist assistant) . Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 91  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
9. NV_BillingGuidelines_PT60_2026-0429.pdf
... .... 3 Units .... 4 Ordering, Prescribing and Referring (OPR) ... or surgical procedures. D9212 Trigeminal division block anesthesia. D9215 Local anesthesia in conjunction ...
Terms matched: 2  -  Score: 147  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
10. NV_BillingGuidelines_PT60.pdf
... .... 3 Units .... 4 Ordering, Prescribing and Referring (OPR) ... or surgical procedures. D9212 Trigeminal division block anesthesia. D9215 Local anesthesia in conjunction ...
Terms matched: 2  -  Score: 147  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
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