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]

Notifications

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:
  • All secure Provider Web Portal (PWP) functions
  • 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)
  • 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.

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

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... 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
... 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
... within the recipient’s Medicaid eligibility. The member is enrolled in an MCO on the ICF/IID Tracking Form is submitted with a date(s ...
Terms matched: 1  -  Score: 52  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICF-IID_Tracking_Form_Validation_Guide_2016-0615.pdf
... EPSDT) program. Managed Care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 52  -  10 Apr 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20230302.pdf
... EPSDT) program. Managed Care For recipients enrolled in a Managed Care Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 52  -  24 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20240410.pdf
... will prevent rebate invoicing for both Fee-for-Service (FFS) and Managed Care Organization (MCO) 340B claims. The Medicaid Management Information System has been updated to accept ...
Terms matched: 1  -  Score: 52  -  01 Jul 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2826_20220701.pdf
... 7. How do I Re-enroll once I've been terminated? You may re-enroll and choose a back date to reduce any lapse of Nevada Medicaid enrollment. To do ...
Terms matched: 1  -  Score: 52  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Enrollment%20Termination%20FAQs%2009-20-16.pdf
... methodology for approved services provided by FQHC qualified health professionals. Managed Care Organizations (MCO) are required to follow Nevada Medicaid’s State Plan and Medicaid ...
Terms matched: 1  -  Score: 52  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
... will prevent rebate invoicing for both Fee-for-Service (FFS) and Managed Care Organization (MCO) 340B claims. The Medicaid Management Information System will be updated to accept ...
Terms matched: 1  -  Score: 52  -  09 Jun 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2801_20220609.pdf
... / Dental Exchange X X Liberty Dental Plan (North) â€" (MCO) X Medical Transportation Management (MCO) X PNC Bank X Price Fass ...
Terms matched: 1  -  Score: 51  -  23 Oct 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Trading%20Partners%20Fully%20Certified%20Report.10.19.18.pdf
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