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]

Notifications

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.

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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... notify sender immediately and shall destroy all information received. DATE OF REQUEST: REQUEST TYPE: Initial Prior Authorization Concurrent Authorization Unscheduled Revision Retrospective Authorization â€" Date ...
Terms matched: 1  -  Score: 23  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
... Some claims submitted by provider types 24- †... 10/2019 2/22/2019 2/ ... will be updated appropriately. 60 Claims, Some institutional ...
Terms matched: 3  -  Score: 840  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... , if present. 273 TYPE OF BILL MISSING 4100 ... /05/2026 Page 22 of 185 Claim Error ... EOB/ANSI Code Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE ...
Terms matched: 3  -  Score: 1037  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... Provider Type 11 Billing Guide Hospital, Inpatient Program Overview A hospital (other than tuberculosis or psychiatric) is a state licensed, Medicare certified inpatient medical facility ...
Terms matched: 1  -  Score: 292  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
... Provider Type 11 Billing Guide Hospital, Inpatient Program Overview A hospital (other than tuberculosis or psychiatric) is a state licensed, Medicare certified inpatient medical facility ...
Terms matched: 1  -  Score: 292  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
... Administrator Joe Lombardo Reno, Nevada 89521 Governor NVHA.NV.GOV Enrollment Moratorium Exemption Request Form Provider Type 33 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) ...
Terms matched: 1  -  Score: 23  -  30 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_Enrollment_Moratorium_Exemption_Request.pdf
... Provider Type 60 Billing Guide School Health Services ( ... Substance Abuse Services .... 22 Nursing Services.... 46 ... Therapy Services .... 47 Occupational Therapy Services.... 53 ...
Terms matched: 3  -  Score: 1788  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
... Provider Type 60 Billing Guide School Health Services ( ... Substance Abuse Services .... 22 Nursing Services .... ... Physical Therapy Services .... 47 Occupational Therapy Services ... ...
Terms matched: 3  -  Score: 1788  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... Community Networks (BHCNs,) Provider Type 14 Specialty 814 Both programs must be ... regarding PHP and IOP Description requirements January 22, 2021 Web Announcement 2415 Attention All ...
Terms matched: 2  -  Score: 55  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2415_20210122.pdf
... Provider Enrollment Checklist Provider Type 14: Behavioral Health Outpatient Treatment Specialty 814: Behavioral Health Community Network Entity/Agency/Group Please refer to the Provider Enrollment ...
Terms matched: 1  -  Score: 96  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Flex.pdf
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