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]

Notifications

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.

Scheduled Site Maintenance

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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... that the service was incorrectly billed, incorrectly paid, or invalid in some other way, federal law requires Medicaid to recover overpayment, regardless of the cause. ...
Terms matched: 1  -  Score: 14  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... that the service was incorrectly billed, incorrectly paid, or invalid in some other way, federal law requires Medicaid to recover overpayment, regardless of the cause. ...
Terms matched: 1  -  Score: 14  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
... regular Medicaid in the PWP: The type of eligibility will not affect the new way of billing for vaccines, as both Nevada Check Up and regular Medicaid will ...
Terms matched: 1  -  Score: 27  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
... regular Medicaid in the PWP: The type of eligibility will not affect the new way of billing for vaccines, as both Nevada Check Up and regular Medicaid will ...
Terms matched: 1  -  Score: 27  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... receiving services under an MCO and then changes to FFS, what is the correct way to request authorization for services to FFS? Is there a grace period if ...
Terms matched: 1  -  Score: 26  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
... . 17 Chapter 4: Prior and retrospective authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Expedited Prior Authorization .... 20 Drug requests... ...
Terms matched: 1  -  Score: 54  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
... . 17 Chapter 4: Prior and retrospective authorization.... 17 Introduction .... 17 Ways to request authorization .... 18 Expedited Prior Authorization .... 20 Drug requests... ...
Terms matched: 1  -  Score: 54  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... Medicaid FAQS 1/9 /2026 Medicaid@nvha.nv.gov 1. Is there a way to give feedback to Nevada Medicaid or tell my story? Fill out this ...
Terms matched: 1  -  Score: 26  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Medicaid%20FAQS.pdf
... regular Medicaid in the PWP: The type of eligibility will not affect the new way of billing for vaccines, as both Nevada Check Up and regular Medicaid will ...
Terms matched: 1  -  Score: 27  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... . 17 Chapter 4: Prior and retrospective authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Drug requests.... 20 Submission deadlines .... ...
Terms matched: 1  -  Score: 54  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
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