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  -  01 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20230523.pdf
... including Fee-For-Service (FFS) recipients and those participating in a Managed Care Organization (MCO) . Prescribers must submit all PA requests to MMA for review and approval ...
Terms matched: 1  -  Score: 38  -  30 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3201_20231030.pdf
... EVV system. Essentials to Know: State EVV Sandata Users: If a provider chooses to use the state EVV system through Sandata, they can continue to have ...
Terms matched: 1  -  Score: 37  -  11 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3186_20231011.pdf
... 13 and 14, 2023, those who reside in a Managed Care Organization (MCO) coverage area were placed back into their last Managed Care Plan that they ...
Terms matched: 1  -  Score: 55  -  09 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3184_20231009.pdf
... claim to the appropriate by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the re- cipient ...
Terms matched: 1  -  Score: 24  -  02 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2020%20Issue%203_20231002.pdf
... Medicaid does not place a limit on the number of covered days. The 180-day MCO coverage requirement applies to every nursing facility admission, regardless of the recipient receiving ...
Terms matched: 1  -  Score: 68  -  27 Sep 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3175_20230927.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
... nursing facility services. If a recipient was enrolled in a Managed Care Organization (MCO) upon admission, that MCO is responsible for the first 45 days of ...
Terms matched: 1  -  Score: 38  -  25 Aug 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19_20191125.pdf
... nursing facility services. If a recipient was enrolled in a Managed Care Organization (MCO) upon admission, that MCO is responsible for the first 180 days of ...
Terms matched: 1  -  Score: 38  -  24 Aug 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT19.pdf
... paid claims as recouped to allow PT 63 to submit the claims to the appropriate MCO. Results of the reprocessed claims will appear on a future remittance advice. ...
Terms matched: 1  -  Score: 39  -  07 Aug 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3141_20230807.pdf
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