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]

Featured Links

DHCFP EVV

Authorization Criteria

DHCFP Home

EDI Information

PWP User Manual

Provider Flex

Online Provider Enrollment

Provider Login (PWP)

Prior Authorization

Search Fee Schedule

Search Providers

Claims

Trading Partner

Self-Paced Training Videos

Notifications

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.

Provider Links

DHCFP EVV

Billing Information

Forms

Provider Enrollment

Provider Newsletters

Provider Training

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

Enhance your search:
  • Note that you can use "*" and "?" as wildcards.

  • Enclosing more than one word in double quotes ("search engine") will search for the exact phrase.
Example Zoom search template page

Search this site

Enter one or more keywords to search for using the Zoom Search Engine.
Note that '*' and '?' wildcards are supported.



Match:

Search results for: choose mco

70 results found containing all search terms. 729 results found containing some search terms.

80 pages of results.
Sort by relevance / Sorted by date ▲
101. Opioid_Partial_Agonists_2016-1216.pdf
... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 16  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Partial_Agonists_2016-1216.pdf
102. NV_BillingGuidelines_PT11_online_070110.pdf
... enrolled in a Managed Care exclusions, coordination of benefits and other terms Organization (MCO), request prior authorization and conditions set forth by the benefit program. ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_070110.pdf
103. newsletter_v7i3.pdf
... verify that the break-out session conference, which will address recipient eligibility, prior you choose has your provider type indicated next to it. authorization, clinical claim editor ...
Terms matched: 1  -  Score: 27  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v7i3.pdf
104. NV_BillingGuidelines_PT54_20160309.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 110  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20160309.pdf
105. NV_BillingGuidelines_PT22_20111205.pdf
... emergency dental care only until the recipient is transitioned to a Managed Care Organization (MCO) at the beginning of their second full month of eligibility. After transitioning ...
Terms matched: 1  -  Score: 79  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20111205.pdf
106. NV_BillingGuidelines_PT11_online_100115.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_100115.pdf
107. newsletter_v5i4.pdf
... and Behavioral Health Sessions First Health Services and the Division of Health Care Fi nancing MCO Update: DHCFP Contracts and Policy offer free, comprehensive training throughout the year ...
Terms matched: 1  -  Score: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v5i4.pdf
108. NV_BillingGuidelines_PT11_online_022715.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_022715.pdf
109. web_announcement_1191_20160722.pdf
... Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. ï ‚ The provider will need to submit a new ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1191_20160722.pdf
110. NV_BillingGuidelines_PT63_20100625.pdf
... Guide A Residential Treatment Center (RTC) is a A Managed Care Organization (MCO) mental health facility having 17 beds or provides all medical care (e.g ...
Terms matched: 1  -  Score: 49  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20100625.pdf
Result Pages: << Previous 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Next >>

Search powered by Zoom Search Engine



Search took 0.064 seconds