Nevada Medicaid and Nevada Check Up News (First 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 Sunday, June 29, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • 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 coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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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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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101. EVS User Manual Chapter 2 o072417-n122818 Modernization.pdf
... the Nevada Medicaid and Nevada Check Up program as well as Managed Care Organizations (MCO) and Third Party Liability (TPL) . The eligibility request is sent ...
Terms matched: 1  -  Score: 228  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS%20User%20Manual%20Chapter%202%20o072417-n122818%20Modernization.pdf
102. 837_Encounter-Dental_837D_MCO_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 228  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Dental_837D_MCO_Mod_n061818.pdf
103. companionguide837P.pdf
... Nevada Medicaid and Nevada Check Up Professional Health Care Claims and Managed Care Organization (MCO) Encounters Nevada Medicaid Management Information System (NV MMIS) State of Nevada ...
Terms matched: 1  -  Score: 223  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P.pdf
104. companionguide837I.pdf
... Nevada Medicaid and Nevada Check Up Institutional Health Care Claims and Managed Care Organization (MCO) Encounter Claims Nevada Medicaid Management Information System (NV MMIS) State of ...
Terms matched: 1  -  Score: 223  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837I.pdf
105. 837_Encounter-Professional_837P_MCO_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 222  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Professional_837P_MCO_Mod_n061818.pdf
106. companionguide837D.pdf
... Nevada Medicaid and Nevada Check Up Dental Health Care Claims and Managed Care Organization (MCO) Encounter Claims Nevada Medicaid Management Information System (NV MMIS) State of ...
Terms matched: 1  -  Score: 213  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837D.pdf
107. NV_Medicaid_News_2017-0714.pdf
... , 2017. Upgrades to the Nevada Medicaid Provider Web Portal that benefit all (MCO) Changes Effective providers will include: July 1, 2017 ï ‚ increased ...
Terms matched: 1  -  Score: 211  -  04 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2017-0714.pdf
108. 837_Encounter-Institutional_837I_MCO_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 210  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Institutional_837I_MCO_Mod_n061818.pdf
109. NDC_Frequently_Asked_Questions.pdf
... sections that follow provide details on Fee-For-Service (FFS) and Managed Care Organization (MCO) Claims. Fee-for-service claims Q: Why does Nevada Medicaid require a National ...
Terms matched: 1  -  Score: 189  -  10 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NDC_Frequently_Asked_Questions.pdf
110. web_announcement_2655_20211215.pdf
... Announcement 2655 Attention All Providers: Recipients May Request to Change Managed Care Organization (MCO) Plans In December, Medicaid recipients who are members of Managed Care Organizations ...
Terms matched: 1  -  Score: 186  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2655_20211215.pdf
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