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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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1. Error_Code_to_EOB_to_ANSI.pdf
... invalid replacement claim ADJUSTED manually priced or contained a PAD detail. Void submission/ ... FOR REV BILL RULE 1581 Diagnos(es) not allowable for the billed 96 ...
Terms matched: 2  -  Score: 62  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT17_Spec181.pdf
... www.nevadamedicaid.nv.gov/ . • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types • MSM Chapter 400 â ...
Terms matched: 1  -  Score: 23  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
3. NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... /dhcfp.nv.gov. • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types • MSM Chapter 400 â ...
Terms matched: 1  -  Score: 23  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... Check Up programs. State Policy Nevada Medicaid determines state policy. This policy is contained in the Medicaid Services Manual (MSM), which is also published on ...
Terms matched: 1  -  Score: 28  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. NV_Billing_General.pdf
... , respectively, all rights reserved. AMA and ADA assume no liability for data contained or not contained in this manual. Updated 02/20/2026 Billing ...
Terms matched: 1  -  Score: 143  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
6. NV_Billing_General_20260101.pdf
... , respectively, all rights reserved. AMA and ADA assume no liability for data contained or not contained in this manual. Updated 01/01/2026 Billing ...
Terms matched: 1  -  Score: 143  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
7. NV_EVS_User_Manual_Ch1.pdf
... first requires accessing the Nevada Medicaid Provider website. The top frame of the website contains a menu of tabs for main website content. Menu Bar The Menu Bar ...
Terms matched: 1  -  Score: 154  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
8. NV_Flex_User_Guide_Getting_Started.pdf
... to 20 characters in length, cannot be the same as your User ID or contain the user’s first or last name, and must contain at ...
Terms matched: 1  -  Score: 73  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
9. NV_BillingGuidelines_PT85_Spec320.pdf
... MSM Chapter 400 covers policy for Behavioral Health providers • MSM Chapter 100 contains important information applicable to all provider types, including information regarding medical necessity Covered ...
Terms matched: 1  -  Score: 21  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
10. Known_Issues.pdf
... /5 /2019 2/18/2019 N/A Submission, that contains other insurance information, as the o Option 1: Enter a new claim ...
Terms matched: 1  -  Score: 14  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
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