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]

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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time on Sunday, March 22, 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 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 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. Error_Code_to_EOB_to_ANSI.pdf
... loop 2110 Service Payment Information REF), if present. 703 BILLING PERIOD EXCEEDS 90 DAYS 703 Billing Period exceeds 90 days 16 Claim/service lacks information or ...
Terms matched: 1  -  Score: 155  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Provider_Enrollment_Information_Booklet.pdf
... : • 989: Community Health Worker Doula Services Specialty type codes: 90 • 890: Doula (Group) • 990: ...
Terms matched: 1  -  Score: 109  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. NV_Billing_General_20260101.pdf
... is provided (or after discharge), a retrospective authorization may be requested within 90 calendar days from the DOD. Retroactive eligibility does not apply to Nevada Check ...
Terms matched: 1  -  Score: 47  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
4. NV_Billing_General.pdf
... is provided (or after discharge), a retrospective authorization may be requested within 90 calendar days from the DOD. Retroactive eligibility does not apply to Nevada Check ...
Terms matched: 1  -  Score: 47  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
5. NV_EVS_User_Manual_Ch1.pdf
... " 91 days • Red Alert â€" Revalidation Date is with 90 â€" 1 days 17 1.6. Updating provider profile The My Profile ...
Terms matched: 1  -  Score: 13  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
6. Known_Issues.pdf
... allowed per lifetime) when the service is rendered for the same tooth numbers. 90 Claims Some claims submitted between 6/7 /19 and • ...
Terms matched: 1  -  Score: 11  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
7. NV_EVS_User_Manual_Ch3.pdf
... 79 3.7.4 Verifying claim status through member focused viewing.... 85 Additional Resources .... 90 PWP User Manual, Chapter 3 Updated 02/17/2026 (pv ...
Terms matched: 1  -  Score: 31  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
8. Nevada Medicaid FAQS.pdf
... ? You can change your health plan (Managed Care Plan) in the first 90 days after you enroll in Medicaid. Here is the form: Final NMO-5006E ...
Terms matched: 1  -  Score: 51  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Medicaid%20FAQS.pdf
9. NV_BillingGuidelines_PT14_online_011226.pdf
... €¢ Retrospective request (for recipient retroactive eligibility): Submit no later than 90 calendar days from the recipient’s Date of Decision (i.e. ...
Terms matched: 1  -  Score: 131  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
10. NV_BillingGuidelines_PT14.pdf
... €¢ Retrospective request (for recipient retroactive eligibility): Submit no later than 90 calendar days from the recipient’s Date of Decision (i.e. ...
Terms matched: 1  -  Score: 131  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
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