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
... re-processed and units on units have been used. the PA will be adjusted. 43 Claims, CLIA Some claims are denying inappropriately as the • Provider ...
Terms matched: 1  -  Score: 24  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... , if present. 3299 HOLIDAY PAY TV MOD BILLED - NOT A 2001 Deny ... : 05/05/2026 Page 43 of 185 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 31  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT60.pdf
... + = Add-on code Provider Type 60 Billing Guide pv 12/16/2025 43 / 78 Provider Type 60 Billing Guide School Health Services (SHS) Outpatient ...
Terms matched: 1  -  Score: 11  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
4. NV_BillingGuidelines_PT60_2025-1216.pdf
... + = Add-on code Provider Type 60 Billing Guide pv 08/28/2024 43 / 78 Provider Type 60 Billing Guide School Health Services (SHS) Outpatient ...
Terms matched: 1  -  Score: 11  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
5. Provider_Enrollment_Information_Booklet.pdf
... /21/2026 Provider Type Number Description and Specialties Laboratory, Pathology/Clinical 43 Specialty type code: • 943: Laboratory, Pathology/Clinical ...
Terms matched: 1  -  Score: 57  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... edit when the recipient is identified as a female. Please refer to the PT 43 Billing Guide for additional information on billing and claims. Gynecological Exams Providers may ...
Terms matched: 1  -  Score: 26  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
7. NV_BillingGuidelines_PT20-24-77.pdf
... edit when the recipient is identified as a female. Please refer to the PT 43 Billing Guide for additional information on billing and claims. Gynecological Exams Providers may ...
Terms matched: 1  -  Score: 26  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
8. NV_BillingGuidelines_PT43.pdf
... Provider Type 43 Billing Guide Laboratory, Pathology Clinical Clinical laboratory tests are furnished primarily in three distinct settings: physician office laboratories, hospital-based laboratories, and independent ...
Terms matched: 1  -  Score: 247  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
9. NV_BillingGuidelines_PT43_20251118.pdf
... Provider Type 43 Billing Guide Laboratory, Pathology Clinical Clinical laboratory tests are furnished primarily in three distinct settings: physician office laboratories, hospital-based laboratories, and independent ...
Terms matched: 1  -  Score: 234  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20251118.pdf
10. NV_Billing_General.pdf
... 38, 40-41, 33 and ICN designations; updated requirements for the Claim Appeal 43 process; and ICD-10 effective date 02/20/2015 Added DMEPOS to ...
Terms matched: 1  -  Score: 28  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
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