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. FA-11.pdf
... notify sender immediately and shall destroy all information received. DATE OF REQUEST: REQUEST TYPE: Initial Prior Authorization Concurrent Authorization Unscheduled Revision Retrospective Authorization â€" Date ...
Terms matched: 1  -  Score: 23  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. Known_Issues.pdf
... Claims, Some claims submitted by provider types 24- • Provider: ... 4 Units Allowed Per Day-PA Override) 21 Claims Code 92133-(Cmptr Ophth ...
Terms matched: 2  -  Score: 619  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... REF), if present. 273 TYPE OF BILL MISSING 4100 The type of ... if present. 332 ENCOUNTER POS = 21 HOSP ADMIT DATE 2400 Encounter Place of ...
Terms matched: 2  -  Score: 370  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT11.pdf
... Provider Type 11 Billing Guide Hospital, Inpatient Program Overview A hospital (other than tuberculosis or psychiatric) is a state licensed, Medicare certified inpatient medical facility ...
Terms matched: 1  -  Score: 292  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
5. NV_BillingGuidelines_PT11_online_082725.pdf
... Provider Type 11 Billing Guide Hospital, Inpatient Program Overview A hospital (other than tuberculosis or psychiatric) is a state licensed, Medicare certified inpatient medical facility ...
Terms matched: 1  -  Score: 292  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
6. DME_Enrollment_Moratorium_Exemption_Request.pdf
... Administrator Joe Lombardo Reno, Nevada 89521 Governor NVHA.NV.GOV Enrollment Moratorium Exemption Request Form Provider Type 33 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) ...
Terms matched: 1  -  Score: 23  -  30 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_Enrollment_Moratorium_Exemption_Request.pdf
7. NV_BillingGuidelines_PT60_2025-1216.pdf
... Provider Type 60 Billing Guide School Health Services (SHS) Table of Contents ... three years old, but under age 21. State Policy For complete coverage and ...
Terms matched: 2  -  Score: 639  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
8. NV_BillingGuidelines_PT60.pdf
... Provider Type 60 Billing Guide School Health Services (SHS) Table of Contents ... in Nevada Medicaid and be under age 21. State Policy For complete coverage and ...
Terms matched: 2  -  Score: 639  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
9. web_announcement_2415_20210122.pdf
... /Substance Abuse Services. For Behavioral Health Community Networks (BHCNs,) Provider Type 14 Specialty 814 Both programs must be prior authorized. The authorizations are submitted ...
Terms matched: 1  -  Score: 38  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2415_20210122.pdf
10. NV_EnrollmentChecklist_PT14_Flex.pdf
... Provider Enrollment Checklist Provider Type 14: Behavioral Health Outpatient Treatment Specialty 814: Behavioral Health Community Network Entity/Agency/Group Please refer to the Provider Enrollment ...
Terms matched: 1  -  Score: 96  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Flex.pdf
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