Nevada Medicaid and Nevada Check Up News (Fourth 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]

Notifications

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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.

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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... provider on the approved PA. Work with the occurrence has been reached. PBM vendor to correct provider information. 3032 TOOTH CODE BILLED DOES NOT MATCH PA 505 ...
Terms matched: 1  -  Score: 11  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... Provider. Gainwell Technologies is the current Quality Improvement Organization (QIO) -like vendor for the Nevada Medicaid and Nevada Check Up programs. State Policy Nevada Medicaid ...
Terms matched: 1  -  Score: 14  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 157  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 157  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
... Health Maintenance • Registered Nurse • Office Manager • Vendor Organization • Hospital • Registered Nurse • Billing ...
Terms matched: 1  -  Score: 14  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
... MSM Chapter 400. If you need further clarification, please contact the Medicaid QIO-like vendor. Qualified Provider Types as noted in the following table: APRN: Advanced ...
Terms matched: 1  -  Score: 12  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
... MSM Chapter 400. If you need further clarification, please contact the Medicaid QIO-like vendor. Qualified Provider Types as noted in the following table: LCPC: Licensed ...
Terms matched: 1  -  Score: 12  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
... of Nevada requirements. It is imperative that Electronic Health Records (EHR) system vendors are vetted to ensure minimum requirements can be met. Data submissions will consist ...
Terms matched: 1  -  Score: 66  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
... MSM Chapter 400. If you need further clarification, please contact the Medicaid QIO-like vendor. Qualified Provider Types as noted in the following table: LCPC: Licensed ...
Terms matched: 1  -  Score: 14  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 157  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
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