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]

Notifications

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.

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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... Scaling and Root Planning) • D1206-(Topical Fluoride Varnish) 20 Claims Claims may be denying inappropriately with the • Provider: No ...
Terms matched: 1  -  Score: 230  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... : 05/05/2026 Page 20 of 185 Claim Error/EOB/ ... Information REF), if present. 400 DETAIL UNITS OF SERVICE MUST BE 1830 ...
Terms matched: 2  -  Score: 91  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... list and include PT 12 or PT 20 as the rendering provider and the transplant ... Manual (MSM) Chapters 200 and 400 for additional policy and guidelines. Providers ...
Terms matched: 2  -  Score: 65  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
... list and include PT 12 or PT 20 as the rendering provider and the transplant ... Manual (MSM) Chapters 200 and 400 for additional policy and guidelines. Providers ...
Terms matched: 2  -  Score: 65  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
... Service Limitations 97161 Physical therapy evaluation, low complexity. Requiring these • 20 minutes = 1 unit components: • Limit 1 unit per day ...
Terms matched: 1  -  Score: 81  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... Service Limitations 97161 Physical therapy evaluation, low complexity. Requiring these • 20 minutes = 1 unit components: • Limit 1 unit per day ...
Terms matched: 1  -  Score: 81  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
... Outpatient Program (IOP) policy language in Medicaid Services Manual (MSM) Chapter 400 Mental Health and Alcohol/Substance Abuse Services. For Behavioral Health Community Networks ...
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... 29/2026 Provider Enrollment Checklist, PT 14 Specialty 814 pv(06/20/2025) Page 1 of 2 Provider Enrollment Checklist Provider Type 14: ...
Terms matched: 1  -  Score: 36  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Flex.pdf
... :00 p.m. to 2:30 p.m. Outpatient Behavioral Health Wednesday May 20, 2026 11:00 a.m. to 12:30 p.m. Workshop ...
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... . 16 Out-of-State Catchment Providers .... 20 Table 4: Nevada Medicaid Catchment Areas ... Health Outpatient Treatment Group • 400*: Ordering, Prescribing, Referring ...
Terms matched: 2  -  Score: 383  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
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