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.

Monday - Friday
12:00AM - 12:30AM

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8:00PM - 12:00AM

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1. FA-11.pdf
... of benefits and other terms and conditions set forth by the benefit program. The ... Nevada Medicaid and Nevada Check Up Behavioral Health Outpatient or Rehabilitative Authorization Request Upload ...
Terms matched: 2  -  Score: 111  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. Known_Issues.pdf
... a resolution is reference not set to an instance of ... units allowed per calendar year-PA up with impacted providers once ... Provider type 32 Therapeutic to Residence) or GR- ...
Terms matched: 3  -  Score: 68  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... same/similar procedure within set CARE COORDINATOR time frame ... /invalid information on the UP TIME Time submission/ ... the facility where the patient resides. this code for ...
Terms matched: 3  -  Score: 466  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... of benefits and other terms and conditions set forth by the benefit program. Hospitals ... included on Nevada Medicaid/Nevada Check Up claims or those claims will be denied ...
Terms matched: 2  -  Score: 66  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. NV_BillingGuidelines_PT11.pdf
... of benefits and other terms and conditions set forth by the benefit program. Hospitals ... included on Nevada Medicaid/Nevada Check Up claims or those claims will be denied ...
Terms matched: 2  -  Score: 66  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
6. NV_BillingGuidelines_PT60.pdf
... non-covered service or a non-covered setting, then documentation of ... segment is performed, round up to the next unit ... not for an inpatient or resident of a †...
Terms matched: 3  -  Score: 311  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. NV_BillingGuidelines_PT60_2025-1216.pdf
... non-covered service or a non-covered setting, then documentation of ... segment is performed, round up to the next unit ... not for an inpatient or resident of a †...
Terms matched: 3  -  Score: 311  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
8. NV_EnrollmentChecklist_PT14_Flex.pdf
... an office location. - Is this setting a gated community? Yes No ___ ... . In the recipient’s residence. - Is this in a gated ...
Terms matched: 2  -  Score: 91  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Flex.pdf
9. FA-91.pdf
... Nevada Medicaid and Check Up Nevada Medicaid Hospice Program Action Form Upload this form through the Provider Web Portal. For questions regarding this form, call: ( ...
Terms matched: 1  -  Score: 26  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-91.pdf
10. Provider_Enrollment_Information_Booklet.pdf
... extend the timely filing policy set forth in Medicaid Services ... Nevada Medicaid and Nevada Check Up programs. To bill ... Nevada is unavailable for recipients residing near state borders, ...
Terms matched: 3  -  Score: 88  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
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