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. Known_Issues.pdf
... 06/2023 02/21/2023 NA Inpatient) are being denied or cut back • Once resolved, claims will be inappropriately with error codes ...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 3383 STERILIZATION FORM REQUIRED - HDR 383 Length of Stay Cut Back by Date of 252 An attachment/other documentation is N3 Missing consent ...
Terms matched: 1  -  Score: 22  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT22-attachmentA.pdf
... EXCISN OF JOINT MEMBRANE 00 NC 00 D7858 TMJ RECONSTRUCTION 01 NC 01 D7860 TMJ CUTTING INTO JOINT 00 NC 00 D7865 TMJ RESHAPING COMPONENTS 00 NC 00 D7870 TMJ ...
Terms matched: 1  -  Score: 49  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
4. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... EXCISN OF JOINT MEMBRANE 00 NC 00 D7858 TMJ RECONSTRUCTION 01 NC 01 D7860 TMJ CUTTING INTO JOINT 00 NC 00 D7865 TMJ RESHAPING COMPONENTS 00 NC 00 D7870 TMJ ...
Terms matched: 1  -  Score: 49  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
5. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
6. NV_BillingGuidelines_PT22-attachmentB.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 Updated 02/02/2026 pv ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
7. NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
8. NV_BillingGuidelines_PT33_20250623.pdf
... ¢ Air conditioners (includes swamp coolers) • Appliances (microwave, cutting boards or other adaptive equipment for cooking, cleaning, etc.) â ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
9. NV_BillingGuidelines_PT33.pdf
... ¢ Air conditioners (includes swamp coolers) • Appliances (microwave, cutting boards or other adaptive equipment for cooking, cleaning, etc.) â ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
10. NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
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