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
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  • 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
... ) with Provider Specialty automatically reprocessed. Clinics) 215-(Substance Abuse Agency Model (SAAM)) for procedure code H0038-(Self-Help/Peer Services ...
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
... provider on the approved PA. Work with occurrence has been reached. the PBM vendor to correct provider information. 3032 TOOTH CODE BILLED DOES NOT MATCH 505 Tooth ...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT11.pdf
... a proprietary, nationally recognized standard utilized by Nevada Medicaid’s QIO -like vendor to perform utilization management, determine medical necessity, and appropriate level of care ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... is a proprietary, nationally recognized standard utilized by Nevada Medicaid’s QIO-like vendor to perform utilization management, determine medical necessity, and appropriate level of care ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. web_announcement_2415_20210122.pdf
... 2415 Attention All Behavioral Health Community Network (BHCN) Groups and Substance Abuse Agency Model (SAAM) Groups: Updated Medicaid Policy for Partial Hospitalization Program (PHP ...
Terms matched: 1  -  Score: 41  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2415_20210122.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... Improvement Organization (QIO) -like vendor for the Nevada Medicaid and Nevada Check ... • 308: Day Treatment Model 14 • 814: Behavioral ...
Terms matched: 2  -  Score: 28  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_BillingGuidelines_PT20-24-77.pdf
... Integration Behavioral Health Integration Services to Nevada Medicaid recipients are provided utilizing the Collaborative Care Model (CoCM) . The CoCM is when a primary care provider identifies a ...
Terms matched: 1  -  Score: 14  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
8. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... Integration Behavioral Health Integration Services to Nevada Medicaid recipients are provided utilizing the Collaborative Care Model (CoCM) . The CoCM is when a primary care provider identifies a ...
Terms matched: 1  -  Score: 14  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
9. NV_BillingGuidelines_PT87_Spec250_090324.pdf
... NRS) 449.0915, Crisis Stabilization Centers (CSCs), which are the hospital-based model of ICSS, will accept all patients without regard to: • ...
Terms matched: 1  -  Score: 26  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250_090324.pdf
10. NV_EnrollmentChecklist_PT87_Spec034_Flex.pdf
... ) providers are community-based facilities delivering intensive crisis stabilization services following a 23-hour 59-minute delivery model. These providers shall obtain a unique and separate NPI for their delivery of ...
Terms matched: 1  -  Score: 23  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT87_Spec034_Flex.pdf
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