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]

Notifications


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 14 and 82:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 9, 2025 – June 16, 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 March 2025 Professional Claims. See Web Announcement 3616.

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.

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

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... the webpage. Prior authorization Emergency transportation services for Fee-for-service and Managed Care Organization (MCO) recipients do not require prior authorization. Payment is contingent upon eligibility, ...
Terms matched: 1  -  Score: 108  -  07 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_932_online_20200430.pdf
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the first month of admission ...
Terms matched: 1  -  Score: 108  -  29 Apr 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20170724.pdf
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the first month of admission ...
Terms matched: 1  -  Score: 108  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20141010.pdf
... , placental transfer data in this patient subpopulation, women sometimes feel the need to choose between treatment and starting a family. The FDA recognized the need for robust ...
Terms matched: 1  -  Score: 107  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_November_2018.pdf
... Members 32 Standard Reports 37 Psychotropics for Children Clinical Presentation 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 105  -  16 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_July_2020.pdf
... information documented in the Fee for Service (FFS) or Managed Care Organization (MCO) policy billing manuals. Nevada Medicaid currently consists of three different health care ...
Terms matched: 1  -  Score: 104  -  15 Sep 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1259_20161103.pdf
... through evaluation, a recipient may elect to disenroll from the Managed Care Organization (MCO) . The MCO is required to notify DHCFP of such election. If ...
Terms matched: 1  -  Score: 104  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20050601.pdf
... information documented in the Fee-for- Service (FFS) or Managed Care Organization (MCO) policy and billing manuals. Nevada Medicaid consists of four different health care ...
Terms matched: 1  -  Score: 104  -  21 Sep 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1447_20170921.pdf
... . Select a Site Key image 8. Enter a unique Passphrase 8 9. Choose 3 Challenge Questions from the 9 dropdown list and create a unique answer for ...
Terms matched: 1  -  Score: 103  -  06 Nov 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PWP_Professional_FINAL_061820.pdf
... . Select a Site Key image 8. Enter a unique Passphrase 8 9. Choose 3 Challenge Questions from the 9 dropdown list and create a unique answer for ...
Terms matched: 1  -  Score: 103  -  01 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nevada%20Provider%20Training%20-%20Professional.pdf
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