Nevada Medicaid and Nevada Check Up News (First 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. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 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)
    • Known System Issues-Click HERE

    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    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. Known_Issues.pdf
... Nursing Facilities must have at least one payable accommodation revenue code on the claim. 80 Claims, Dental Some dental claims are being denied incorrectly • Provider ...
Terms matched: 1  -  Score: 23  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... 319 Diagnosis not allowed for abortion CPTs 80 PROCEDURE CODE NOT PAYABLE WITH 11 The ... about restrictions for this service. 5731 200 UNITS ALLOWED PER ROLLING 5731 200 UNITS ...
Terms matched: 2  -  Score: 81  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT11.pdf
... care and treatment of mental disease. See Medicaid Services Manual (MSM) Chapters 200 and 400 for additional policy and guidelines. Providers who have difficulty placing an ...
Terms matched: 1  -  Score: 148  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... care and treatment of mental disease. See Medicaid Services Manual (MSM) Chapters 200 and 400 for additional policy and guidelines. Providers who have difficulty placing an ...
Terms matched: 1  -  Score: 148  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. DME_Enrollment_Moratorium_Exemption_Request.pdf
... OF THE MEDICAID INSPECTOR GENERAL Stacie Weeks, Director 9850 Double R Blvd, Suite 200 Cynthia Leech, Administrator Joe Lombardo Reno, Nevada 89521 Governor NVHA.NV.GOV Enrollment Moratorium ...
Terms matched: 1  -  Score: 41  -  30 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_Enrollment_Moratorium_Exemption_Request.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... ) 58 • 199: Chore (EVV Required) • 200: Environmental Accessibility Adaptations • 202: Personal Emergency Response System ( ...
Terms matched: 1  -  Score: 25  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... purchase) â€" 1 unit per 3 yrs A4287 Disposable collection and storage 200 units per 30 rolling days bag for breast milk Prior authorization for breast pumps ...
Terms matched: 1  -  Score: 12  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
8. NV_BillingGuidelines_PT20-24-77.pdf
... purchase) â€" 1 unit per 3 yrs A4287 Disposable collection and storage 200 units per 30 rolling days bag for breast milk Prior authorization for breast pumps ...
Terms matched: 1  -  Score: 12  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
9. NV_Billing_General_20260101.pdf
... discuss a relevant service type. The MSM chapters are: 100: Medicaid Program 200: Hospital Services 300: Radiology Services 400: Mental Health Services 500: ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
10. NV_Billing_General.pdf
... discuss a relevant service type. The MSM chapters are: 100: Medicaid Program 200: Hospital Services 300: Radiology Services 400: Mental Health Services 500: ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
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