Nevada Medicaid and Nevada Check Up News (Third 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 Sunday, November 9, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • 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)
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for September 2025 Professional Claims. See Web Announcement 3745.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.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. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
2. HMG CoA Reductase Inhibitors.pdf
... 3 ): 427-37. 104. Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, et al. Effect ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG%20CoA%20Reductase%20Inhibitors.pdf
3. HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
... 3 ): 427-37. 104. Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, et al. Effect ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
4. E-Binder_PT_September_2018.pdf
... ) . August 2017. ï ‚ Crouse JR 3rd, Raichlen JS, Riley WA, et al. Effect of rosuvastatin on progression of carotid intima-media thickness in ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_September_2018.pdf
5. E-Binder_PT_September_2017.pdf
... ) . May 2016. ï ‚ Crouse JR 3rd, Raichlen JS, Riley WA, et al. Effect of rosuvastatin on progression of carotid intima-media thickness in ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_September_2017.pdf
6. E-Binder_PT_March_2018.pdf
... ) . August 2017. ï ‚ Crouse JR 3rd, Raichlen JS, Riley WA, et al. Effect of rosuvastatin on progression of carotid intima-media thickness in ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_March_2018.pdf
7. E-Binder_December_2015.pdf
... Clin Psychopharmacol. 2001;21:425-31. 63. Kok RM, Nolen WA, Heeren TJ. Venlafaxine vs nortriptyline in the treatment of elderly depressed inpatients ...
Terms matched: 1  -  Score: 25  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_December_2015.pdf
8. Dopamine_Agonists_2013-0812.pdf
... Med. 2010 Oct;11(9 ): 848-56. 43. Hening WA, Allen RP, Ondo WG, Walters AS, Winkelman JW, Becker ...
Terms matched: 1  -  Score: 59  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Dopamine_Agonists_2013-0812.pdf
9. Dopamine Agonists 2012 12.pdf
... Med. 2010 Oct;11(9 ): 848-56. 43. Hening WA, Allen RP, Ondo WG, Walters AS, Winkelman JW, Becker ...
Terms matched: 1  -  Score: 59  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Dopamine%20Agonists%202012%2012.pdf
10. Bisphosphonates 2014 11.pdf
... :299-305. 49. Harris ST, Reginster JY, Harley C, Blumentals WA, Poston SA, Barr CE, et al. Risk of fracture in ...
Terms matched: 1  -  Score: 28  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Bisphosphonates%202014%2011.pdf
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