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

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time on Sunday, March 29, 2026, for scheduled maintenance:
  • Claims Submission through the secure Provider Web Portal (PWP)
  • Secure Correspondence, including Claim Appeals, through the secure Provider Web Portal (PWP)
  • Real time CAQH/CORE EDI eligibility and claim verification

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.

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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... . 1 Nevada Medicaid Provider Types and Specialties .... ... Application is Submitted .... 45 Electronic Fund Transfer ( ... Diseases Clinic • 120: Hematology †...
Terms matched: 3  -  Score: 816  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... Provider Type 43 Billing Guide Laboratory, Pathology Clinical Clinical laboratory tests are furnished primarily in three distinct settings: physician office laboratories, hospital-based laboratories, and independent ...
Terms matched: 1  -  Score: 273  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
... Provider Type 43 Billing Guide Laboratory, Pathology Clinical Clinical laboratory tests are furnished primarily in three distinct settings: physician office laboratories, hospital-based laboratories, and independent ...
Terms matched: 1  -  Score: 273  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20251118.pdf
... , Claims submitted by Provider Type 17, †... on this claim type) 45 Claims, Some Medicare ... Resolved (If Applicable) 120 Claims, Some claims ...
Terms matched: 3  -  Score: 419  -  24 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... €¢ This form must be submitted the day of the absence for any other type of absence. Upload this request through the Provider Web Portal. Questions? ...
Terms matched: 1  -  Score: 102  -  20 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-13A.pdf
... 1:00 p.m. to 2:30 p.m. Groups Therapy (Provider Type 34) Tuesday April 21, 2026 10:00 a.m. to 11 ...
Terms matched: 1  -  Score: 36  -  19 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3870_20260319.pdf
... . Policy Juvenile Justice screening and diagnostics services should be provided by the following provider types (PT): • PT 14 â€" Behavioral Health ...
Terms matched: 1  -  Score: 16  -  18 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Justice_Initiative.pdf
... Provider Type 87 Specialty 250 Billing Guide Crisis Services: Crisis Stabilization Center Overview Intensive Crisis Stabilization Services (ICSS) offer the community no-wrong-door access to mental health ...
Terms matched: 1  -  Score: 221  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250_090324.pdf
... Provider Enrollment Checklist Provider Type 87: Crisis Services Specialty 034: Intensive Crisis Stabilization Services (ICSS) Please refer to the Provider Enrollment Information Booklet for guidance ...
Terms matched: 1  -  Score: 74  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT87_Spec034_Flex.pdf
... Provider Enrollment Checklist Provider Type 87: Crisis Services Specialty 033: Mobile Crisis Team (MCT) Please refer to the Provider Enrollment Information Booklet for guidance and ...
Terms matched: 1  -  Score: 74  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT87_Spec033_Flex.pdf
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