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. Known_Issues.pdf
... (Referring NPI required) when the ordering NPI is entered appropriately with the â ... that has been trimmed, bent, molded, assembled, or otherwise customized to ...
Terms matched: 2  -  Score: 55  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... Identification Segment (loop 2110 Service Payment Information REF), if present. 1062 ORDERING NPI REQUIRED 1062 Ordering NPI is required. 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 150  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT11_online_082725.pdf
... €¢ Admissions initiated through emergency or observation when a physician writes the inpatient admission order. • Obstetric or newborn admissions: 1. that, from ...
Terms matched: 1  -  Score: 80  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
4. NV_BillingGuidelines_PT11.pdf
... €¢ Admissions initiated through emergency or observation when a physician writes the inpatient admission order. • Obstetric or newborn admissions: 1. that, from ...
Terms matched: 1  -  Score: 80  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
5. NV_BillingGuidelines_PT60_2025-1216.pdf
... .... 3 Incorrectly Billed Claims.... 3 Modifiers.... 3 Units .... 4 Ordering, Prescribing and Referring (OPR) Provider Requirements.... 4 Rates.... 5 ...
Terms matched: 1  -  Score: 225  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
6. NV_BillingGuidelines_PT60.pdf
... 3 Incorrectly Billed Claims .... 3 Modifiers .... 3 Units .... 4 Ordering, Prescribing and Referring (OPR) Provider Requirements .... 4 Rates.... ...
Terms matched: 1  -  Score: 225  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. FA-91.pdf
... of Death: ____ A Discharge cannot be processed without an accompanying signed physician order and discharge summary. SECTION II: CHANGE OF HOSPICE PROVIDER I/Legal ...
Terms matched: 1  -  Score: 21  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-91.pdf
8. Provider_Enrollment_Information_Booklet.pdf
... Nevada Medicaid and Nevada Check Up programs. To bill for services rendered or to order, prescribe, and refer services to Nevada Medicaid recipients (hereafter referred to ...
Terms matched: 1  -  Score: 211  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
9. NV_BillingGuidelines_PT65.pdf
... PA) number on the claim. Retain the PA number for your records. Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 116  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65.pdf
10. NV_BillingGuidelines_PT65_online_20230126.pdf
... PA) number on the claim. Retain the PA number for your records. Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 116  -  20 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65_online_20230126.pdf
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