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

Monday
8:00PM - 12:00AM

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1. FA-11.pdf
... of Request: _____ SECTION IV. CURRENT SYMPTOMS AND SIGNIFICANT LIFE EVENTS (List symptoms and/or significant life events that relate to the recipient’ ...
Terms matched: 1  -  Score: 21  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. Known_Issues.pdf
... 2026 | Page 1 The Known Issues List provides up-to-date information on current issues related ... that has been trimmed, bent, molded, assembled, or otherwise customized to ...
Terms matched: 2  -  Score: 84  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... or HCPCS submission/billing error(s ) . Usage: Do not use listing for valid procedure codes. this code for claims attachment(s )/ ...
Terms matched: 1  -  Score: 147  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT11.pdf
... pertinent information in the synopsis. Authorization requests must be received within the time frames listed below. • Prior authorization must be obtained before non-emergent inpatient admission ...
Terms matched: 1  -  Score: 81  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
5. NV_BillingGuidelines_PT11_online_082725.pdf
... pertinent information in the synopsis. Authorization requests must be received within the time frames listed below. • Prior authorization must be obtained before non-emergent inpatient admission ...
Terms matched: 1  -  Score: 81  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
6. DME_Enrollment_Moratorium_Exemption_Request.pdf
... ), and why you believe there is access to care issues within the areas listed. 3. REQUIRED DOCUMENTATION All of the following must be submitted with the ...
Terms matched: 1  -  Score: 20  -  30 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_Enrollment_Moratorium_Exemption_Request.pdf
7. NV_BillingGuidelines_PT60.pdf
... do not require prior authorization. See the Provider Type 60 Fee Schedule for a list of available procedure codes. Third Party Liability (TPL) If a recipient ...
Terms matched: 1  -  Score: 300  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
8. NV_BillingGuidelines_PT60_2025-1216.pdf
... do not require prior authorization. See the Provider Type 60 Fee Schedule for a list of available procedure codes. Third Party Liability (TPL) If a recipient ...
Terms matched: 1  -  Score: 300  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
9. web_announcement_2415_20210122.pdf
... authorization is considered a concurrent PA submission. Both PHP and IOP are to be listed and described, with evidence-based practice(s ), within the Quality Assurance ...
Terms matched: 1  -  Score: 20  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2415_20210122.pdf
10. web_announcement_3897_20260421.pdf
... and/or staff are invited to attend one or more of the training sessions listed below that are being held in May 2026. Please visit the Provider Training ...
Terms matched: 1  -  Score: 23  -  22 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3897_20260421.pdf
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