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.

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1. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... OFF BONE 00 00 00 D7560 MAXILLARY SINUSOTOMY 00 00 00 D7610 MAXILLA OPEN REDUCT SIMPLE 00 00 00 D7620 CLSD REDUCT SIMPL MAXILLA FX 00 00 00 D7630 OPEN ...
Terms matched: 1  -  Score: 49  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
2. NV_BillingGuidelines_PT22-attachmentA.pdf
... OFF BONE 00 00 00 D7560 MAXILLARY SINUSOTOMY 00 00 00 D7610 MAXILLA OPEN REDUCT SIMPLE 00 00 00 D7620 CLSD REDUCT SIMPL MAXILLA FX 00 00 00 D7630 OPEN ...
Terms matched: 1  -  Score: 49  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
3. NV_Billing_General.pdf
... and certify transactions. Establishing a Trading Partner Profile (TPP) agreement is a simple process which the Trading Partner completes using the Nevada Medicaid Provider Web Portal link ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. NV_Billing_General_20260101.pdf
... and certify transactions. Establishing a Trading Partner Profile (TPP) agreement is a simple process which the Trading Partner completes using the Nevada Medicaid Provider Web Portal link ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
5. NV_BillingGuidelines_PT34.pdf
... response to hypoxia (hypoxia response Not Required curve) 94620 Pulmonary stress testing, simple (e.g., 6-minute walk test, Not Required prolonged exercise test for ...
Terms matched: 1  -  Score: 24  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
6. NV_BillingGuidelines_PT34_2023-1121.pdf
... response to hypoxia (hypoxia response Not Required curve) 94620 Pulmonary stress testing, simple (e.g., 6-minute walk test, Not Required prolonged exercise test for ...
Terms matched: 1  -  Score: 24  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
7. NV_BillingGuidelines_PT74.pdf
... but are not limited to, the following: Procedure Code Procedure Code Description 10060 Simple or single drainage of skin abscess 11200, 11201 Removal of skin tags 36415 ...
Terms matched: 1  -  Score: 12  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74.pdf
8. NV_BillingGuidelines_PT74_20250821.pdf
... but are not limited to, the following: Procedure Code Procedure Code Description 10060 Simple or single drainage of skin abscess 11200, 11201 Removal of skin tags 36415 ...
Terms matched: 1  -  Score: 12  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74_20250821.pdf
9. NV_Billing_General_20251017.pdf
... and certify transactions. Establishing a Trading Partner Profile (TPP) agreement is a simple process which the Trading Partner completes using the Nevada Medicaid Provider Web Portal link ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
10. NV_Billing_General_20251215.pdf
... and certify transactions. Establishing a Trading Partner Profile (TPP) agreement is a simple process which the Trading Partner completes using the Nevada Medicaid Provider Web Portal link ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
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