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, October 25, 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 September 2026 Professional Claims. See Web Announcement 4031.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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
8:00PM - 12:00AM

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1. NV_EnrollmentChecklist_PT63_Spec715.pdf
... Issues Conduct Disorder Co-Occurring Disorders Developmental Dual Diagnosis Eating Disorders Disabilities 10/20/2026 Provider Enrollment Checklist, PT 63 Specialty 715 Page 1 of 2 Provider Enrollment ...
Terms matched: 1  -  Score: 36  -  20 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT63_Spec715.pdf
2. Provider_Enrollment_Information_Booklet.pdf
... A: Definitions .... 45 Provider Enrollment Information Booklet i 10/19/2026 Welcome! Thank you for your interest in the Nevada Medicaid and Nevada Check ...
Terms matched: 1  -  Score: 350  -  19 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. FA-11E.pdf
... History Co-occurring diagnoses: Current symptoms and relevant history: Updated 10/14/2026 FA-11E (pv07/13/2026) Gainwell Technologies Prior Authorization Contact Center ...
Terms matched: 1  -  Score: 242  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
4. FA-11D.pdf
... Secondary Code: description: Tertiary Code: description: Updated 10/14/2026 FA-11D (pv08/01/2026) Gainwell Technologies Prior Authorization Contact Center ...
Terms matched: 1  -  Score: 218  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11D.pdf
5. FA-12.pdf
... yes, enter facilities and service dates below.) Updated 10/14/2026 FA-12 (pv07/13/2026 Gainwell Technologies Prior Authorization Contact Center: ...
Terms matched: 1  -  Score: 165  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-12.pdf
6. FA-11.pdf
... 2. 3. 4. 5. 6. Updated 10/14/2026 FA-11 (pv07/13/2026) Gainwell Technologies Prior Authorization Contact Center ...
Terms matched: 1  -  Score: 130  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
7. FA-11B.pdf
... Secondary Code: Disorder: Tertiary Code: Disorder: Updated 10/14/2026 FA-11B (pv07/13/2026) Gainwell Technologies Prior Authorization Contact Center ...
Terms matched: 1  -  Score: 130  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11B.pdf
8. FA-14.pdf
... Describe the recipient’s current mental status: Updated 10/14/2026 FA-14 (pv07/13/2026) Gainwell Technologies Prior Authorization Contact Center ...
Terms matched: 1  -  Score: 103  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-14.pdf
9. NV_BillingGuidelines_PT85.pdf
... terms and conditions set forth by the benefit program. Updated 10/13/2026 Provider Type 85 Billing Guide pv 07/27/2026 Gainwell Technologies is ...
Terms matched: 1  -  Score: 163  -  13 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85.pdf
10. NV_BillingGuidelines_PT85_20260727.pdf
... terms and conditions set forth by the benefit program. Updated 07/27/2026 Provider Type 85 Billing Guide pv 12/22/2025 Gainwell Technologies is ...
Terms matched: 1  -  Score: 95  -  13 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_20260727.pdf
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