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. FA-11.pdf
... County Point of Contact: Date recipient went into State/County custody: SECTION II. ICD-10 DIAGNOSIS (If using DC:0-3, use the appropriate crosswalk ...
Terms matched: 1  -  Score: 21  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. NV_BillingGuidelines_PT11_online_082725.pdf
... Level I 0170 / 0171 InterQual I / MCG Level I / Transitional Care Level II 0172 InterQual II / MCG Level II Level III 0173 InterQual III & IV ...
Terms matched: 1  -  Score: 34  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
3. NV_BillingGuidelines_PT11.pdf
... Level I 0170 / 0171 InterQual I / MCG Level I / Transitional Care Level II 0172 InterQual II / MCG Level II Level III 0173 InterQual III & IV ...
Terms matched: 1  -  Score: 34  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
4. NV_BillingGuidelines_PT60.pdf
... , LCPC, QBA and Clinical Additional Instructions: Intensity of Needs Level I & II, maximum of Interns working 6 hours per 90-day period; Level III, ...
Terms matched: 1  -  Score: 38  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
5. NV_BillingGuidelines_PT60_2025-1216.pdf
... , LCPC, QBA and Clinical Additional Instructions: Intensity of Needs Level I & II, maximum of Interns working 6 hours per 90-day period; Level III, ...
Terms matched: 1  -  Score: 38  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
6. FA-91.pdf
... Discharge cannot be processed without an accompanying signed physician order and discharge summary. SECTION II: CHANGE OF HOSPICE PROVIDER I/Legal Representative/Agent for the recipient ...
Terms matched: 1  -  Score: 21  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-91.pdf
7. FA-30.pdf
... home, parents, ICF/IID, SNF, etc.): SECTION II: CLINICAL INFORMATION Is this a request for ICF/IID? Yes No ...
Terms matched: 1  -  Score: 23  -  16 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30.pdf
8. FA-30-I.pdf
... of 4 Updated: 04/16/2026 pv07/10/2017 SECTION II: CLINICAL INFORMATION • Is this a request for ICF/IID ...
Terms matched: 1  -  Score: 21  -  16 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30-I.pdf
9. NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... Note that for distant site services billed under Critical Access Hospital (CAH) method II on institutional claims and billed by outpatient providers on institutional claims, the GT ...
Terms matched: 1  -  Score: 20  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
10. NV_Billing_General.pdf
... updated. Updated 02/20/2026 Billing Manual Pv01/01/2026 ii Date (mm/dd/yyyy) Description of changes Pages impacted 02 ...
Terms matched: 1  -  Score: 41  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
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