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]

Featured Links

DHCFP EVV

Authorization Criteria

DHCFP Home

EDI Information

PWP User Manual

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 on Sunday, January 25, 2026, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • 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)

EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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

76 results found containing all search terms. 741 results found containing some search terms.

82 pages of results.
Sorted by relevance / Sort by date
171. Anthem_DUR_Binder_April_2021.pdf
... Presentation Presented to NV DUR Board on April 22, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 103  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2021.pdf
172. web_announcement_655_20131021.pdf
... when a managed care recipient is allowed to switch from one Managed Care Organization (MCO) to the other. Previously, a recipient (with no other household ...
Terms matched: 1  -  Score: 102  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_655_20131021.pdf
173. NV_BillingGuidelines_PT22_20160608.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: 100  -  29 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20160608.pdf
174. companionguide834.pdf
... , Cancellations and Audits. It counts all recipients with at least one day of MCO enrollment in the current or subsequent month. Ethnicity Codes The 834 transaction includes ...
Terms matched: 1  -  Score: 100  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide834.pdf
175. NV_BillingGuidelines_PT22_20080827.pdf
... and recipient is transitioned to a Managed Care routine maintenance to promote dental Organization (MCO) at the beginning of health. their second full month of eligibility. ...
Terms matched: 1  -  Score: 100  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20080827.pdf
176. NV_BillingGuidelines_PT22_20090801.pdf
... and recipient is transitioned to a Managed Care routine maintenance to promote dental Organization (MCO) at the beginning of health. their second full month of eligibility. ...
Terms matched: 1  -  Score: 100  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20090801.pdf
177. SilverSummit_DUR_Binder_April_2021.pdf
... Reports â€" 32 Multiple Sclerosis Agents Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 100  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_April_2021.pdf
178. NV_BillingGuidelines_PT22_20110621.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
179. web_announcement_3815_20260109.pdf
... Announcement 3815 Rural Medicaid Provider Reminder: Continuity of Care & Managed Care Organization (MCO) Coordination effective January 1, 2026 Please note that the message below is ...
Terms matched: 1  -  Score: 98  -  13 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3815_20260109.pdf
180. Behavioral_Health_Training_032819.pdf
... Authorization Forms, continued • While on the Forms page, locate and choose appropriate forms • Make sure that instructions are followed • ...
Terms matched: 1  -  Score: 97  -  28 Mar 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Behavioral_Health_Training_032819.pdf
Result Pages: << Previous 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Next >>

Search powered by Zoom Search Engine



Search took 0.053 seconds