Nevada Medicaid and Nevada Check Up News (Third Quarter 2025 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, December 21, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • 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)

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.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-attachmentB.pdf
... copyrighted by the American Medical Association (AMA) and the American Dental Association (ADA), respectively, all rights reserved. CPT is a registered trademark  ...
Terms matched: 1  -  Score: 31  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
2. NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... copyrighted by the American Medical Association (AMA) and the American Dental Association (ADA), respectively, all rights reserved. CPT is a registered trademark  ...
Terms matched: 1  -  Score: 31  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
3. NV_Billing_General.pdf
... by the American Medical Association (AMA), and the American Dental Association (ADA), respectively, all rights reserved. AMA and ADA assume no liability ...
Terms matched: 1  -  Score: 52  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. Error_Code_to_EOB_to_ANSI.pdf
... /incomplete/invalid procedure code(s ) . TERMINATION CMS, AMA or ADA for the Date of Service. submission/billing error(s ) . ...
Terms matched: 1  -  Score: 11  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
5. NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... copyrighted by the American Medical Association (AMA) and the American Dental Association (ADA), respectively, all rights reserved. CPT is a registered trademark  ...
Terms matched: 1  -  Score: 31  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
6. web_announcement_3774_20251119.pdf
... dental encounters for FQHCs will be transitioned to billing on the American Dental Association (ADA) form with the encounter code D2999. After this transition, Nevada Medicaid ...
Terms matched: 1  -  Score: 21  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3774_20251119.pdf
7. web_announcement_3735_20251002.pdf
... and should be submitted on all regular dental claims in the American Dental Association (ADA) format. The rate for code D2999 will be the same as code ...
Terms matched: 1  -  Score: 20  -  19 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3735_20251002.pdf
8. web_announcement_3755_20251027.pdf
... ), Healthcare Common Procedure Coding System (HCPCS) and American Dental Association (ADA) codes will adjudicate without first being suspended due to rates not in the ...
Terms matched: 1  -  Score: 21  -  27 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3755_20251027.pdf
9. Benefit_Enrollment_and_Maintenance_(834).pdf
... insurance and insurance-related business processes. www.x12.org. • American Dental Association (ADA): Develops and maintains a standardized data set for use by dental organizations ...
Terms matched: 1  -  Score: 11  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
10. NV_Billing_General_20250801.pdf
... by the American Medical Association (AMA), and the American Dental Association (ADA), respectively, all rights reserved. AMA and ADA assume no liability ...
Terms matched: 1  -  Score: 52  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
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