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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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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291. Provider_Enrollment_(Emergency-Individual).pdf
... need to be changed. Select the Attachment Type from the drop-down menu. Select Choose File and locate the appropriate document for uploading. Once the document is placed ...
Terms matched: 1  -  Score: 12  -  25 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_(Emergency-Individual).pdf
292. NV_BillingGuidelines_PT56.pdf
... Care vs. Fee-for-Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. For ...
Terms matched: 1  -  Score: 36  -  25 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56.pdf
293. NV_BillingGuidelines_PT63_20201210.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: 118  -  24 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20201210.pdf
294. NV_BillingGuidelines_PT63.pdf
... FFS) Medicaid. If the recipient is enrolled in a Managed Care Organization (MCO), the MCO is responsible for reimbursement of the RTC stay. Recipients ...
Terms matched: 1  -  Score: 141  -  21 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63.pdf
295. web_announcement_2635_20211119.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to communicate ...
Terms matched: 1  -  Score: 117  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2635_20211119.pdf
296. web_announcement_2616_20211021.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to communicate ...
Terms matched: 1  -  Score: 117  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2616_20211021.pdf
297. web_announcement_2649_20211209.pdf
... 1, 2022. Medicaid recipient membership is currently with three Managed Care Organization (MCO) plans, and DHCFP will distribute the membership across the four plans on ...
Terms matched: 1  -  Score: 77  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2649_20211209.pdf
298. web_announcement_2655_20211215.pdf
... Announcement 2655 Attention All Providers: Recipients May Request to Change Managed Care Organization (MCO) Plans In December, Medicaid recipients who are members of Managed Care Organizations ...
Terms matched: 1  -  Score: 186  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2655_20211215.pdf
299. web_announcement_2683_20220114.pdf
... Attention All Providers: Notify Medicaid Recipients to Act Immediately if They Wish to Switch MCO Plans Nevada Medicaid recipients who wish to change Managed Care Organization (MCO) ...
Terms matched: 1  -  Score: 126  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2683_20220114.pdf
300. web_announcement_2657_20211216.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to communicate ...
Terms matched: 1  -  Score: 117  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2657_20211216.pdf
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