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]

Featured Links

DHCFP EVV

Authorization Criteria

DHCFP Home

EDI Information

PWP User Manual

Provider Flex

Online Provider Enrollment

Provider Login (PWP)

Prior Authorization

Search Fee Schedule

Search Providers

Claims

Trading Partner

Self-Paced Training Videos

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.

Provider Links

DHCFP EVV

Billing Information

Forms

Provider Enrollment

Provider Newsletters

Provider Training

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

70 results found containing all search terms. 729 results found containing some search terms.

80 pages of results.
Sorted by relevance / Sort by date
251. Atypical (Second-Generation) Antipsychotics_07232012.pdf
... first 1 to 2 weeks of therapy; therefore, this must be considered when choosing an agent for 10 the acute treatment of schizophrenia. Lurasidone is indicated for ...
Terms matched: 1  -  Score: 59  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Atypical%20(Second-Generation)%20Antipsychotics_07232012.pdf
252. web_announcement_2658_20211217.pdf
... 2658 Attention All Providers: Recipient/Enrollee Webpage Created with Managed Care Organization (MCO) Expansion Information Effective immediately, a new webpage has been created on the ...
Terms matched: 1  -  Score: 58  -  17 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2658_20211217.pdf
253. NV_BillingGuidelines_PT75_20111111.pdf
... DHCFP that have swing bed licensure and certification. Requesting Authorization To request authorization: MCO vs. FFS ï ‚ Complete and fax form FA-3 or FA-8 as When ...
Terms matched: 1  -  Score: 58  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_20111111.pdf
254. Anthem_DUR_Binder_Jan_2021.pdf
... Presentation Presented to NV DUR Board on January 28, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 57  -  06 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Jan_2021.pdf
255. 2_Medicaid_Program_Highlights_DHCFP_2014.pdf
... • Advanced Practice Registered Nurses • Physician Forums with FFS and MCO • Prior Authorization Alignment between FFS and MCO • Health ...
Terms matched: 1  -  Score: 57  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2_Medicaid_Program_Highlights_DHCFP_2014.pdf
256. web_announcement_988_20150929.pdf
... for no prior authorization due to a change in eligibility from Managed Care Organization (MCO) to Fee-for-Service (FFS) after a newborn’s date of ...
Terms matched: 1  -  Score: 56  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_988_20150929.pdf
257. web_announcement_1353_20170417.pdf
... the Direct Managed Care Enrollment process to enroll recipients into their Managed Care Organization (MCO) immediately upon approval of their Medicaid eligibility. This change will give Medicaid ...
Terms matched: 1  -  Score: 56  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1353_20170417.pdf
258. E-Binder_SSSB_September_2021.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 56  -  16 Sep 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_September_2021.pdf
259. PT_13_Psychiatric_Hospital_Inpatient_Training_2019.pdf
... in their answer to 4 the Challenge Question to verify identity. 5 4. Choose whether log in is on a personal computer or public computer. 5. ...
Terms matched: 1  -  Score: 56  -  12 Jun 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_13_Psychiatric_Hospital_Inpatient_Training_2019.pdf
260. web_announcement_3184_20231009.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
Result Pages: << Previous 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Next >>

Search powered by Zoom Search Engine



Search took 0.054 seconds