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]

Notifications

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 5 p.m. Pacific Time on Sunday, September 27, 2026, through 2 a.m. Pacific Time on Monday, September 28, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • Provider Flex
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

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.

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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... health care professional on the same day of the procedure or other service AH Licensed Board of Examiners Psychologist AM Physician, team member service CO Outpatient Occupational Therapy Assistant ...
Terms matched: 1  -  Score: 85  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
... health care professional on the same day of the procedure or other service AH Licensed Board of Examiners Psychologist AM Physician, team member service CO Outpatient Occupational Therapy Assistant ...
Terms matched: 1  -  Score: 85  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.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
... Specialized Foster Care Checklist. 173 Provider; Group During the group enrollment process, board • Provider: No action required at this 12/19/ ...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... the moratorium exemption request form. ____ ____ Owner/Managing Employee/Board Member Name Title ____ ____ Owner/Managing Employee/Board Member ...
Terms matched: 1  -  Score: 35  -  30 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_Enrollment_Moratorium_Exemption_Request.pdf
... health care professional on the same day of the procedure or other service AH Licensed Board of Examiners Psychologist AM Physician, team member service CO Outpatient Occupational Therapy Assistant ...
Terms matched: 1  -  Score: 85  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
... CFR 59.5(b )( 6 ) School Based Health • State Board of Medical Examiners license for Medical 17 179 Centers (SBHC) Director Federally ...
Terms matched: 1  -  Score: 246  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... Care Covered services Providers should bill using their provider type 65 to receive room and board reimbursement for those hospice recipients residing in a nursing facility. Medicaid provides coverage ...
Terms matched: 1  -  Score: 47  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65_online_20230126.pdf
... Providers should bill using their provider type (PT) 65 to receive room and board reimbursement for those hospice recipients residing in a nursing facility. Medicaid provides coverage ...
Terms matched: 1  -  Score: 47  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65.pdf
... conducted by a qualified, non-enrolled lactation health care professional, such as an International Board Certified Lactation Consultant (IBCLC), can be billed under a PT 20 ...
Terms matched: 1  -  Score: 12  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
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