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: 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.

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.
... 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
... 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
Result Pages: << Previous 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Next >>

Search powered by Zoom Search Engine



Search took 0.053 seconds