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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231. web_announcement_9_120203.pdf
... feature, however, you may continue to print and complete handwritten forms if you choose. All forms must be mailed or faxed to First Health Services (see ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_9_120203.pdf
232. web_announcement_166_111607.pdf
... the 837I and UB-04 claims, until 5/23/08, if you choose. Test Your Claims Now! Medicare encourages submitters to send a small number ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_166_111607.pdf
233. NV_BillingGuidelines_PT54 o100111-online120511-n110215.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%20o100111-online120511-n110215.pdf
234. web_announcement_352_20100917.pdf
... tips and instructions, timely filing, appeals and many more topics. Providers may choose to attend a morning or an afternoon conference in either Reno or Las Vegas ...
Terms matched: 1  -  Score: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_352_20100917.pdf
235. NV_EnrollmentChecklist_PT14_Spec_307_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_307_original_041812.pdf
236. NV_BillingGuidelines_PT29_online_20070815.pdf
... Organizations (â €œMCOsâ€) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 24  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20070815.pdf
237. web_announcement_355_20100930.pdf
... beginning Jan. 1, 2011, but may start the process immediately if they choose to do so. Re-enrollment under the new procedures must be completed by Oct ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_355_20100930.pdf
238. Nursing_Facility_Tracking_Form_Validation_Guide_ 2016-0615.pdf
... within the recipient’s Medicaid eligibility. The member is enrolled in an MCO on the NF form is submitted with a recipient that has date(s ...
Terms matched: 1  -  Score: 53  -  20 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nursing_Facility_Tracking_Form_Validation_Guide_%202016-0615.pdf
239. Nursing_Facility_Tracking_Form_Validation_Guide_2016-0615.pdf
... within the recipient’s Medicaid eligibility. The member is enrolled in an MCO on the NF form is submitted with a recipient that has date(s ...
Terms matched: 1  -  Score: 53  -  20 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nursing_Facility_Tracking_Form_Validation_Guide_2016-0615.pdf
240. Nursing Facility Tracking Form Validation Guide 2016-0615.pdf
... within the recipient’s Medicaid eligibility. The member is enrolled in an MCO on the NF form is submitted with a recipient that has date(s ...
Terms matched: 1  -  Score: 53  -  20 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nursing%20Facility%20Tracking%20Form%20Validation%20Guide%202016-0615.pdf
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