Nevada Medicaid and Nevada Check Up News (Fourth 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]

Notifications

NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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.

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

78 results found containing all search terms. 745 results found containing some search terms.

83 pages of results.
Sorted by relevance / Sort by date
... Fee-For-Service • When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. â ...
Terms matched: 1  -  Score: 41  -  29 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT21.pdf
... 31, 2017, dental services for recipients enrolled in a Managed Care Organization (MCO) in Washoe and Clark counties will continue to be managed through Fee-for- ...
Terms matched: 1  -  Score: 41  -  09 Dec 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1480_20171208.pdf
... Announcement 704 6 Quarterly Provider Training Ordering, Prescribing and Referring 7 Quarterly Provider Training MCO and FFS • This new requirement does not apply to orders, ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Quarterly_Provider_Training_Presentation_FINAL_2014-0328.pdf
... Data (Subscriber Information 2100 C Loop) An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 41  -  29 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Premium_Payment_(820).pdf
... – ª Self directed providers disabilities) $175 billion â – ª Providers that choose to accept funds must attest to the terms and conditions in payments to be ...
Terms matched: 1  -  Score: 41  -  14 Aug 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Relief_Fund_Step-by-Step_Provider_Guide.pdf
... authorization Fee-for-Service emergency transport does not require prior authorization. For Managed Care Organization (MCO) enrollees, check with the MCO for special requirements. Covered services The ...
Terms matched: 1  -  Score: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_20140416.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
... the 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: 41  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20111205.pdf
... 1 /2019 6/25/2019 Managed Care, Managed Care Organization (MCO), all details on NDC (National outpatient or outpatient cross-over claims are ...
Terms matched: 1  -  Score: 40  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... 1 /2019 6/25/2019 Managed Care, Managed Care Organization (MCO), all details on NDC (National outpatient or outpatient cross-over claims are ...
Terms matched: 1  -  Score: 40  -  06 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Modernization%20System_Known%20Issues.pdf
Result Pages: << Previous 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Next >>

Search powered by Zoom Search Engine



Search took 0.061 seconds