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
... Amount is Zero), as the Medicare information is not getting copied from the original claim to the resubmitted claim. 26 Claims, Appeals Providers appealing converted legacy ...
Terms matched: 1  -  Score: 43  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... occurrence has been reached. the PBM vendor to correct provider information. 3032 TOOTH ... Enter/Correct the TCN of the original claim to submission/billing error( ...
Terms matched: 2  -  Score: 108  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. NV_BillingGuidelines_PT11.pdf
... Nevada Medicaid’s QIO -like vendor to perform utilization management, determine medical ... or invasive diagnostic testing unrelated to the original reason for admission; or days associated ...
Terms matched: 2  -  Score: 44  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... by Nevada Medicaid’s QIO-like vendor to perform utilization management, determine medical ... or invasive diagnostic testing unrelated to the original reason for admission; or days associated ...
Terms matched: 2  -  Score: 44  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. NV_BillingGuidelines_PT60_2025-1216.pdf
... 77 / 78 Provider Type 60 Billing Guide School Health Services (SHS) The originating site is the location where an eligible Medicaid/Nevada Check Up recipient is ...
Terms matched: 1  -  Score: 29  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
6. NV_BillingGuidelines_PT60.pdf
... 77 / 78 Provider Type 60 Billing Guide School Health Services (SHS) The originating site is the location where an eligible Medicaid/Nevada Check Up recipient is ...
Terms matched: 1  -  Score: 29  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. Provider_Enrollment_Information_Booklet.pdf
... Improvement Organization (QIO) -like vendor for the Nevada Medicaid and Nevada Check ... be dated within 5 years of the original date of service. Enrollments require a ...
Terms matched: 2  -  Score: 31  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
8. FA-30.pdf
... : ____ If there is no plan, burial assistance from the county of origin may be available and can be applied for at the time of death. ...
Terms matched: 1  -  Score: 20  -  16 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30.pdf
9. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... Fetal Once per pregnancy for: • A potential defect noted in the original ultrasound (76805 or 76811) • A high risk of a ...
Terms matched: 1  -  Score: 33  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
10. NV_BillingGuidelines_PT20-24-77.pdf
... Fetal Once per pregnancy for: • A potential defect noted in the original ultrasound (76805 or 76811) • A high risk of a ...
Terms matched: 1  -  Score: 33  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
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