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

NOTIFICATION:The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, June 29, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • 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)

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 Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 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 May 2025 Professional Claims. See Web Announcement 3651.

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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... 2023 32 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 195  -  13 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20231130.pdf
... : This temporary solution does not apply to Managed Care Organization payers or providers who choose to use an alternative EVV system. Temporary claims submission: The good news ...
Terms matched: 1  -  Score: 21  -  01 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3294_20240301.pdf
... coverage period. Rather, at any time during the 180-day coverage period, an MCO may assess whether a recipient can be discharged to a lower level of care ...
Terms matched: 1  -  Score: 36  -  22 Feb 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3285_20240222.pdf
... benefit eligibility. A. Medicaid recipients with a Nevada Medicaid Managed Care Organization (MCO) may contact their respective MCO: https://dhcfp.nv.gov/Members ...
Terms matched: 1  -  Score: 35  -  02 Jan 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3232_20231208.pdf
... to the appropriate ered by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the recipient belongs to ...
Terms matched: 1  -  Score: 24  -  28 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2020%20Issue%204_20231228.pdf
... in Nevada WebIZ, unless the patient chooses to opt-out of inclusion in the system ... €" Medicaid Fee-For-Service • MCO â€" Managed Care Organization â ...
Terms matched: 2  -  Score: 55  -  21 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/COVID-19_General_Billing_Guide.pdf
... €™s service limits are met. • For a provider who chooses to submit a PA request when the recipient has not exhausted their service limitations ...
Terms matched: 1  -  Score: 21  -  20 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3245_20231220.pdf
... to pay CCBHCs providing services under a contract with a Medicaid Managed Care Organization (MCO; also known as a Managed Care Entity [MCE]) additional payments ...
Terms matched: 1  -  Score: 23  -  06 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20220118.pdf
... to pay CCBHCs providing services under a contract with a Medicaid Managed Care Organization (MCO; also known as a Managed Care Entity [MCE]) additional payments ...
Terms matched: 1  -  Score: 23  -  06 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
... . Electronic 1099s will be available starting with the 2023 tax year. Providers that choose not to obtain their 1099s electronically can also use the EVS Demographic Updates feature ...
Terms matched: 1  -  Score: 21  -  01 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3229_20231201.pdf
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