Nevada Medicaid and Nevada Check Up News (First Quarter 2026 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. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 2026, for scheduled maintenance:
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    • Known System Issues-Click HERE

    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

    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 https://NevadaMedicaid.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.

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241. NV_BillingGuidelines_PT10_20150929.pdf
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 36  -  25 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20150929.pdf
242. NV_BillingGuidelines_PT22_20170629.pdf
... emergency dental care only until the recipient is transitioned to a Managed Care Organization (MCO) at the beginning of their second full month of eligibility. ï ‚ ...
Terms matched: 1  -  Score: 138  -  29 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20170629.pdf
243. NV_BillingGuidelines_PT22_20160608.pdf
... emergency dental care only until the recipient is transitioned to a Managed Care Organization (MCO) at the beginning of their second full month of eligibility. ï ‚ ...
Terms matched: 1  -  Score: 100  -  29 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20160608.pdf
244. NV_BillingGuidelines_PT46_20150929.pdf
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 36  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46_20150929.pdf
245. NV_BillingGuidelines_PT63_20141010.pdf
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the first month of admission ...
Terms matched: 1  -  Score: 108  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20141010.pdf
246. web_announcement_1404_20170630.pdf
... urban Washoe counties will no longer be managed by the current Managed Care Organizations (MCO) . As of July 1, 2017, dental services and claims will ...
Terms matched: 1  -  Score: 41  -  30 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1404_20170630.pdf
247. web_announcement_1405_20170630.pdf
... , and SilverSummit Healthplan. In preparation for the contract start date for the four MCO contracts, the Division of Health Care Financing and Policy (DHCFP) will ...
Terms matched: 1  -  Score: 73  -  01 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1405_20170630.pdf
248. Quick_Tip_Guide_Inpatient_Psychiatric_and_RTC_2014-1030.pdf
... be denied first at the acute level of care. ï ‚ Should the provider choose to not appeal they may request these dates of service at a lower level ...
Terms matched: 1  -  Score: 20  -  10 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Quick_Tip_Guide_Inpatient_Psychiatric_and_RTC_2014-1030.pdf
249. PWP_PCS_Training_2017-07.pdf
... authorized to access. â"€ Choose the Functions you want the delegate to ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for- Service (FFS ...
Terms matched: 2  -  Score: 56  -  19 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PWP_PCS_Training_2017-07.pdf
250. Portal_Upgrade_FAQ.pdf
... have the ability to create prior authorizations in the Provider Web Portal. If providers choose to use the Provider Web Portal, they will eliminate the need to mail ...
Terms matched: 1  -  Score: 20  -  21 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Portal_Upgrade_FAQ.pdf
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