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, September 20, 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 August 2026 Professional Claims. See Web Announcement 4009.

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_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
... service as D7320 for the same quadrant. D7410 RAD EXC LESION UP TO 1.25 CM 00 NC NC D7411 EXCISION BENIGN LESION>1.25C 00 NC NC D7412 EXCISION ...
Terms matched: 1  -  Score: 66  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
2. NV_BillingGuidelines_PT22-attachmentA.pdf
... date of service as D7320 for the same D7410 RAD EXC LESION UP TO 1.25 CM 00 NC NC D7411 EXCISION BENIGN LESION>1.25C 00 NC NC D7412 EXCISION ...
Terms matched: 1  -  Score: 66  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
3. 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
4. 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
5. Error_Code_to_EOB_to_ANSI.pdf
... Payment Information REF), if present. 319 Diagnosis not allowed for abortion CPTs 80 PROCEDURE CODE NOT PAYABLE WITH 11 The diagnosis is inconsistent with the M64 Missing ...
Terms matched: 1  -  Score: 56  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... service as D7320 for the same quadrant. D7410 RAD EXC LESION UP TO 1.25 CM 00 NC NC D7411 EXCISION BENIGN LESION>1.25C 00 NC NC D7412 EXCISION ...
Terms matched: 1  -  Score: 66  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
7. NV_EVS_User_Manual_Ch3.pdf
... number, such as days, or a dollar amount. o For value codes 80 â€" Covered Days and 81 â€" Non Covered Days enter ...
Terms matched: 1  -  Score: 26  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
8. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... part of another procedure 00 tissue D7910 Suture of recent small wounds up to 5 cm 00 None D7961 Buccal / Labial Frenectomy (Frenulectomy) 00 Three in a ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
9. NV_BillingGuidelines_PT22-attachmentB.pdf
... part of another procedure 00 tissue D7910 Suture of recent small wounds up to 5 cm 00 None D7961 Buccal / Labial Frenectomy (Frenulectomy) 00 Three in a ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
10. NV_BillingGuidelines_PT74_20250821.pdf
... postpartum care (Allowed 59510 when assisting physician on cesarean delivery. Bill with modifier 80 or 81) Cesarean only delivery 59514 (Allowed when assisting physician on cesarean ...
Terms matched: 1  -  Score: 34  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74_20250821.pdf
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