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.

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1. Error_Code_to_EOB_to_ANSI.pdf
... REF), if present. 273 TYPE OF BILL MISSING 4100 The type of ... . condition. 360 ADMITTING DIAGNOSIS MISSING 60 Admit Diagnosis is missing or invalid. ...
Terms matched: 2  -  Score: 533  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... Provider Type 17 Specialty 181 Billing Guide Special Clinics: Federally Qualified Health Centers (FQHC) Program Overview Federally Qualified Health Centers (FQHCs) are defined by ...
Terms matched: 1  -  Score: 318  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
3. NV_BillingGuidelines_PT17_Spec181.pdf
... Provider Type 17 Specialty 181 Billing Guide Special Clinics: Federally Qualified Health Centers (FQHC) Program Overview Federally Qualified Health Centers (FQHCs) are defined by ...
Terms matched: 1  -  Score: 305  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
4. NV_BillingGuidelines_PT25-41.pdf
... Provider Types 25 and 41 Billing Guide Optometrist, Optician and Optical Business Policy ... service limit for V2628 is once every 60 months per eye per recipient. â ...
Terms matched: 2  -  Score: 208  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41.pdf
5. NV_BillingGuidelines_PT25-41_20241218.pdf
... Provider Types 25 and 41 Billing Guide Optometrist, Optician and Optical Business Policy ... service limit for V2628 is once every 60 months per eye per recipient. â ...
Terms matched: 2  -  Score: 143  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41_20241218.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... General Information.... 1 Nevada Medicaid Provider Types and Specialties.... 1 Table 1: ... : Facility Based Assisted Living School Based 60 Specialty type code: • ...
Terms matched: 2  -  Score: 449  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. web_announcement_3816_20260112.pdf
... for more information. January 12, 2026 Nevada Medicaid Web Announcement 3816 Attention Provider Types 24 (Advanced Practice Registered Nurses), 74 (Nurse Midwife) and ...
Terms matched: 1  -  Score: 89  -  23 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3816_20260112.pdf
8. NV_Billing_General.pdf
... of all providers, regardless of provider type (PT), at least every ... . Providers who do not revalidate within 60 days of the date on their notification ...
Terms matched: 2  -  Score: 217  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. NV_Billing_General_20260101.pdf
... of all providers, regardless of provider type (PT), at least every ... . Providers who do not revalidate within 60 days of the date on their notification ...
Terms matched: 2  -  Score: 217  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
10. NV_EVS_User_Manual_Ch1.pdf
... they have at least one active provider type, or the provider’s ... last log in date is greater than 60 days from the current date. After ...
Terms matched: 2  -  Score: 64  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
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