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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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

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111. NV_BillingGuidelines_PT22_20080519.pdf
... eligibility For recipients age 21 and older, Nevada programs are not transitioned to an MCO. Medicaid covers only necessary dentures, emergency extractions and palliative care. It ...
Terms matched: 1  -  Score: 183  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20080519.pdf
112. FA-16B.pdf
... ASSESSING THE RECIPIENT’S NEEDS. ASSESSMENT NEEDS MEDICATION/IV DELIVERY NEEDS Choose one: This is based on the severity of illness and the stability of ...
Terms matched: 1  -  Score: 174  -  20 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-16B.pdf
113. NV_Medicaid_News_2017-0424.pdf
... Medicaid Provider Web Portal (PWP) from version 4.0 to version 5.0. (MCO) Changes Effective All user information will be automatically migrated over to the new ...
Terms matched: 1  -  Score: 174  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2017-0424.pdf
114. web_announcement_1331_20170327.pdf
... 27, 2017 Announcement 1331 Attention All Nevada Medicaid Providers: Managed Care Organization (MCO) Changes Effective 2017 Effective July 1, 2017, the Division of Health ...
Terms matched: 1  -  Score: 168  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1331_20170327.pdf
115. web_announcement_1380_20170526.pdf
... 26, 2017 Announcement 1380 Attention All Nevada Medicaid Providers: Managed Care Organization (MCO) Changes Effective 2017 Effective July 1, 2017, the Division of Health ...
Terms matched: 1  -  Score: 168  -  26 May 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1380_20170526.pdf
116. web_announcement_735_20140519.pdf
... of managed care. They will either be enrolled in a Managed Care Organization (MCO) because their household or case members are enrolled in it, because they ...
Terms matched: 1  -  Score: 155  -  29 May 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_735_20140519.pdf
117. Training_FrequentlyAskedQuestions.pdf
... How does EVS notify me that a recipient is in a Managed Care Organization (MCO)? If a recipient is enrolled in an MCO, the detail may ...
Terms matched: 1  -  Score: 150  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Training_FrequentlyAskedQuestions.pdf
118. companionguide837I_hipaa-0-12.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X223A2 Institutional health care claims and MCO encounter claims (837I) 6-1 7. Payer specific business rules and limitations ...
Terms matched: 1  -  Score: 145  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837I_hipaa-0-12.pdf
119. NV_BillingGuidelines_PT63.pdf
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the RTC stay. Recipients ...
Terms matched: 1  -  Score: 141  -  21 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63.pdf
120. NV_BillingGuidelines_PT22_20170629.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. ï ‚ ...
Terms matched: 1  -  Score: 138  -  29 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20170629.pdf
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