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]

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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.

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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
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1. FA-11.pdf
... benefits and other terms and conditions set forth by the benefit program. The information contained in this form, including attachments, is privileged and confidential and is only ...
Terms matched: 1  -  Score: 26  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. 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  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... replacement claim BE ADJUSTED manually priced or contained a PAD detail. submission/billing ... RSTCN FOR REV BILL 1581 Diagnos(es) not allowable for the billed 96 ...
Terms matched: 2  -  Score: 62  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... applicable, to avoid untimely/stale dated billing issues. Each claim can only contain one authorization number. Timely submission of a claim is calculated based on the ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. NV_BillingGuidelines_PT11.pdf
... applicable, to avoid untimely/stale dated billing issues. Each claim can only contain one authorization number. Timely submission of a claim is calculated based on the ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
6. 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  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... for 99492 or 99493. Dermatology services For some dermatology services, the CPT descriptors contain language, such as additional lesion, to indicate that multiple surgical procedures have ...
Terms matched: 1  -  Score: 29  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
8. NV_BillingGuidelines_PT20-24-77.pdf
... for 99492 or 99493. Dermatology services For some dermatology services, the CPT descriptors contain language, such as additional lesion, to indicate that multiple surgical procedures have ...
Terms matched: 1  -  Score: 29  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
9. NV_BillingGuidelines_PT43_20251118.pdf
... ) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter 600 ...
Terms matched: 1  -  Score: 26  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20251118.pdf
10. NV_BillingGuidelines_PT43.pdf
... ) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter 600 ...
Terms matched: 1  -  Score: 26  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
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