Nevada Medicaid and Nevada Check Up News (Fourth 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: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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121. 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
122. 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
123. 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
124. 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
125. 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
126. 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
127. 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
128. 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
129. companionguide837P_hipaa-01-12.pdf
... 6. Instruction tables .... 6-1 6.1. 005010X222A1 Professional health care claims and MCO encounter claims (837P) .... 6-1 7. Payer specific business rules ...
Terms matched: 1  -  Score: 137  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P_hipaa-01-12.pdf
130. ABA_FAQ.pdf
... ) Frequently Asked Questions (FAQ) If a member is receiving services under an MCO and then changes to FFS, what is the correct way to request authorization ...
Terms matched: 1  -  Score: 134  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
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