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
... No Is the recipient in State/County custody? Yes No State/County Point of Contact: Date recipient went into State/County custody: SECTION II ...
Terms matched: 1  -  Score: 42  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... (loop 2110 Service Payment Information REF), if present. 3299 HOLIDAY PAY TV MOD BILLED - NOT A 2001 Deny Holiday Pay TV Modifier when not a ...
Terms matched: 1  -  Score: 22  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. DME_Enrollment_Moratorium_Exemption_Request.pdf
... of the moratorium period; and • Be subject to a Fingerprint-Based Criminal Background Check (FCBC) and Site Visit. 5. APPLICANT ACKNOWLEDGMENT I have ...
Terms matched: 1  -  Score: 20  -  30 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_Enrollment_Moratorium_Exemption_Request.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... . 20 Out of State Providers Urgent/Emergency Services .... 21 Fingerprint-based Criminal Background Check (FCBC) .... 22 License Updates and Voluntary Termination Requests ... ...
Terms matched: 1  -  Score: 51  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... Z34.00, Z34.80, Z34.90, or Z3A.0 - Z3A.49) . Diagnosis’ pointed on the claim line should indicate the complication/reason for the additional visit ...
Terms matched: 1  -  Score: 12  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
6. NV_BillingGuidelines_PT20-24-77.pdf
... Z34.00, Z34.80, Z34.90, or Z3A.0 - Z3A.49) . Diagnosis’ pointed on the claim line should indicate the complication/reason for the additional visit ...
Terms matched: 1  -  Score: 12  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
7. NV_Billing_General_20260101.pdf
... within 90 calendar days, and ABA services, which can be requested at any point within the date range requested on the PA. For a Reconsideration request, ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
8. NV_Billing_General.pdf
... within 90 calendar days, and ABA services, which can be requested at any point within the date range requested on the PA. For a Reconsideration request, ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. NV_BillingGuidelines_PT85_Spec320.pdf
... and high-risk social environments The Health Home for beneficiaries with FASD serves as the central point of contact for coordinating patient-centered care across the broader health care system. Beneficiaries ...
Terms matched: 1  -  Score: 23  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
10. Nevada Medicaid FAQS.pdf
... a checking account (ACH), Visa, Mastercard, or Discover card. Point your smartphone camera at the QR Code below and click the link that appears ...
Terms matched: 1  -  Score: 36  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Medicaid%20FAQS.pdf
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