Nevada Medicaid and Nevada Check Up News (Third Quarter 2025 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 Sunday, November 9, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • 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)

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for September 2025 Professional Claims. See Web Announcement 3745.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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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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1. Known_Issues.pdf
... . Refer to Part 12 of the YouTube Series for Using the PWP 190 Claims ... needed. Provider type 32 Therapeutic to Residence) or GR-(Hospital-based â ...
Terms matched: 2  -  Score: 31  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Provider_Enrollment_Information_Booklet.pdf
... returned application. Visit the Nevada Medicaid YouTube Training Channel for additional instructions on navigating ... care within Nevada is unavailable for recipients residing near state borders, the contiguous out ...
Terms matched: 2  -  Score: 21  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... error(s ) . Usage: Do not use the facility where the patient resides. this code for claims attachment(s )/ other documentation. At ...
Terms matched: 1  -  Score: 11  -  04 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. Benefit_Enrollment_and_Maintenance_(834).pdf
... 2 EM = Email 66 2100A PER06 Email 1/256 68 2100A N3 Member Residence Street Address 68 2100A N301 Subscriber Address 1/55 68 2100A N302 Subscriber ...
Terms matched: 1  -  Score: 53  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
5. NV_Billing_General_20250801.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
6. NV_Billing_General.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_EVS_User_Manual_Ch1.pdf
... Additional Resources Using the Provider Web Portal YouTube Videos: Registering and Multi-Factor Authentication ( ... to perform Pre- Admission Screening and Resident Admission Screening and Resident Review (PASRR ...
Terms matched: 2  -  Score: 35  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
8. NV_EVS_User_Manual_Ch7.pdf
... to close the additional search criteria. 11 Additional Resources Using the Provider Web Portal YouTube Videos: Resources Tab 12 ...
Terms matched: 1  -  Score: 20  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch7.pdf
9. NV_EVS_User_Manual_Ch6.pdf
... Click Close to close the window. 10 Additional Resources Using the Provider Web Portal YouTube Videos: Resources Tab 11 ...
Terms matched: 1  -  Score: 20  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch6.pdf
10. NV_EVS_User_Manual_Ch10.pdf
... if reports meet your search criteria. 14 Additional Resources Using the Provider Web Portal YouTube Videos: Resources Tab 15 ...
Terms matched: 1  -  Score: 20  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch10.pdf
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