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]

Notifications

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.

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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... feature, however, you may continue to print and complete handwritten forms if you choose. All forms must be mailed or faxed to First Health Services (see ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_09_120203.pdf
... €œMedicare & You 2006â€to Medicare recipients. Dual-eligible recipients who do not choose a PDP or Medicare Advantage Plan by the end of the year will be ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v2i4.pdf
... the recipient is transitioned to a certain restorative services and routine Managed Care Organization (MCO) at the maintenance to promote dental health. beginning of their second full ...
Terms matched: 1  -  Score: 100  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20110621.pdf
... €œForms,⠀ attachment has been added to your service and then choose, complete, print and fax the line: appropriate â ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PA_QRG_20120517.pdf
... requires that pro- Although cost savings is a driver, non- gested states choose OPPCs based on viders report conditions identified for payment policies are directed toward these ...
Terms matched: 1  -  Score: 12  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v8i1.pdf
... the EPSDT program. Managed care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20140801.pdf
... also reimbursed in facilities enrolled with DHCFP that have swing bed licensure and certification. MCO vs. FFS When a recipient is enrolled in a Managed Care Organization ( ...
Terms matched: 1  -  Score: 66  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_070314.pdf
... the recipient is transitioned to a certain restorative services and routine Managed Care Organization (MCO) at the maintenance to promote dental health. beginning of their second full ...
Terms matched: 1  -  Score: 95  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20100630.pdf
... . Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. For ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56_20131204.pdf
... . fee for service 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_120511.pdf
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