Nevada Medicaid and Nevada Check Up News (First Quarter 2026 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. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • 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)
    • Known System Issues-Click HERE

    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

    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 https://NevadaMedicaid.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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171. web_announcement_Volume_18_Issue_03_20211011_v2.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume_18_Issue_03_20211011_v2.pdf
172. Nevada Provider Training - Professional.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
173. 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  -  06 Nov 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PWP_Professional_FINAL_061820.pdf
174. web_announcement_Volume 18 Issue 3 v2_20211025.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  25 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2018%20Issue%203%20v2_20211025.pdf
175. web_announcement_Volume%2018%20Issue%203_20211011.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%252018%2520Issue%25203_20211011.pdf
176. 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
177. 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
178. 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
179. 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
180. 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
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