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]

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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.

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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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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221. web_announcement_677_20131219.pdf
... orders, prescriptions or referrals for individuals enrolled in a Medicaid Managed Care Organization (MCO) . It is applicable only to the Nevada Fee for Service (FFS ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_677_20131219.pdf
222. NPI_FrequentlyAskedQuestions.pdf
... I am an atypical provider? First Health Services will issue atypical I did not choose a taxonomy code providers a new provider number by when I registered for my ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NPI_FrequentlyAskedQuestions.pdf
223. NV_EnrollmentChecklist_PT14_Spec_306_original_041812.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing; 7. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Spec_306_original_041812.pdf
224. web_announcement_272_20090708.pdf
... enrollment period during which period they may choose to change their health plan. Recipients ... Web Announcement 272 Managed Care Organization (MCO) Changes: 12-Month Recipient Lock-In Policy ...
Terms matched: 2  -  Score: 83  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_272_20090708.pdf
225. NV_BillingGuidelines_PT38_20100604.pdf
... White Pine, Lander, Eureka, Humboldt, Pershing and Churchill. Recipients who choose self-directed services will be assisted by a Financial Management Service Provider Type 38 Billing ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT38_20100604.pdf
226. NV_EnrollmentChecklist_PT14_82_Policy_Ack_Supervisor_Info.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing g. Only qualified providers provide prescribed services within scope of their practice under ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_82_Policy_Ack_Supervisor_Info.pdf
227. NV_EnrollmentChecklist_PT14-82_QMHP.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing; 7. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14-82_QMHP.pdf
228. NV_BillingGuidelines_PT56_20081024.pdf
... in a Managed per diem rate. General rate information is on Care Organization (MCO), request prior the DHCFP website at http://dhcfp.nv.gov. ...
Terms matched: 1  -  Score: 35  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56_20081024.pdf
229. NV_BillingGuidelines_PT54_20151102.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 110  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20151102.pdf
230. web_announcement_801_20140910.pdf
... be included in each session. When providers register, they will be asked to choose either the morning or afternoon session. Last year’s event, ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_801_20140910.pdf
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