Nevada Medicaid and Nevada Check Up News (Second 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. to midnight Pacific Time on Sunday, August 30, 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)
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims. See Web Announcement 3983.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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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Scheduled Site Maintenance

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. NV_BillingGuidelines_PT22_20230327.pdf
... Nevada Medicaid fiscal agent uses state and federal guidelines to review and determine whether services meet the established requirements for payment. The Provider Web Portal will have the determination ...
Terms matched: 1  -  Score: 24  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20230327.pdf
2. NV_BillingGuidelines_PT22.pdf
... Nevada Medicaid fiscal agent uses state and federal guidelines to review and determine whether services meet the established requirements for payment. The Provider Web Portal will have the determination ...
Terms matched: 1  -  Score: 24  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
3. NV_BillingGuidelines_PT17_Specialty_181_20260306.pdf
... provider. • The FQHC must enroll within the appropriate provider type and meet all MSM coverage guidelines for the specific ancillary service. • Ancillary ...
Terms matched: 1  -  Score: 20  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260306.pdf
4. NV_BillingGuidelines_PT17_Spec181.pdf
... provider. • The FQHC must enroll within the appropriate provider type and meet all MSM coverage guidelines for the specific ancillary service. • Ancillary ...
Terms matched: 1  -  Score: 20  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
5. NV_BillingGuidelines_PT60.pdf
... the POC. • Deemed medically necessary and appropriate. • Meet any Ordering, Prescribing and Referring (OPR) requirements for the service being ...
Terms matched: 1  -  Score: 93  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
6. NV_BillingGuidelines_PT60_2026-0429.pdf
... the POC. • Deemed medically necessary and appropriate. • Meet any Ordering, Prescribing and Referring (OPR) requirements for the service being ...
Terms matched: 1  -  Score: 93  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
7. Pregnancy_Presumptive_Eligibility_Addendum.pdf
... ) business days of all eligible PE determinations. Section 4. Performance Measures 4.1 Meet the DSS accuracy requirement that 94% of PE determinations must be accurate. ...
Terms matched: 1  -  Score: 52  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Addendum.pdf
8. Pregnancy_Presumptive_Eligibility_Instructions.pdf
... is the trained and certified office staff who will be completing the preliminary determinations and meeting the program benchmarks. A provider office may be defined as a qualified entity ...
Terms matched: 1  -  Score: 23  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Instructions.pdf
9. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
10. Known_Issues.pdf
... Claims) Claims and already adjusted/voided) and/or 0075- Workgroup Meeting on 09/16/2019, it Professional (adjustment denied-original payment request ...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
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