Nevada Medicaid and Nevada Check Up News (Third Quarter 2025 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, December 7, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • 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)

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.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. FA-11E.pdf
... voluminous documentation will not be reviewed. Focused Comprehensive Start Date and End Date Required Total Units Code Code Description (May request up to 180 days, Units Per ...
Terms matched: 1  -  Score: 20  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
2. Known_Issues.pdf
... ¢ 270-(Header Total Billed Amount Missing) ... issue has been resolved. 50 Claims, Provider The ... Type 44 Billing Guidelines informs • Provider: ...
Terms matched: 3  -  Score: 101  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... Institution for Mental beds and more than 50% of care is primarily engaged in ... Institution for Mental beds and more than 50% of care is primarily engaged in ...
Terms matched: 2  -  Score: 21  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. Error_Code_to_EOB_to_ANSI.pdf
... Missing/incomplete/invalid total charges. submission/ ... /04/2025 Page 50 of 185 Claim Error ... EOB/ANSI Code Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE ...
Terms matched: 3  -  Score: 511  -  04 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
5. web_announcement_3757_20251103.pdf
... mg, non-preferred strength defined as the 50 mg • Depakene removed from ... mg, non-preferred strength defined as the 50 mg • Depakene removed from ...
Terms matched: 2  -  Score: 45  -  03 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3757_20251103.pdf
6. web_announcement_3753_20251024.pdf
... 75 Baby Essentials Gift Card, $50 Instacart cart and $25 Healthy Food ... 75 Baby Essentials Gift Card, $50 Instacart cart and $25 Healthy Food ...
Terms matched: 2  -  Score: 27  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
7. NV_Flex_User_Guide_Group.pdf
... interest means a person or corporation that: • Has an ownership interest totaling five (5 ) percent or more in a disclosing entity, †...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
8. NV_Flex_User_Guide_Individual.pdf
... interest means a person or corporation that: • Has an ownership interest totaling five (5 ) percent or more in a disclosing entity, †...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
9. Benefit_Enrollment_and_Maintenance_(834).pdf
... Segment Count 1/10 Total number of segments included ... H: Enrollment Source ... 50 Appendix I: Change ... H: Enrollment Source ... 50 Appendix I: Change ...
Terms matched: 3  -  Score: 277  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
10. NV_Billing_General.pdf
... only) • Total units/days billed ... 01/2025 36 o 50 â€" Claim ... Non-Check Related o 51 â€" Adjustments †...
Terms matched: 3  -  Score: 54  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
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