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]

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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time on Sunday, January 25, 2026, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
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    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Provider Flex
  • Gabby®, which includes:
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    • 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)

EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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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361. Health_Plan_of_Nevada_DUR_Binder_July_2021.pdf
... Drug Use Review Board Meeting JULY 22, 2021 2021 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 31  -  15 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_July_2021.pdf
362. E-Binder_SSSB_June_2021.pdf
... 2021. • Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. www.uptodate.com/ . Updated April 11, 2021. ...
Terms matched: 1  -  Score: 10  -  09 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_June_2021.pdf
363. Quick_Tip_Guide_Inpatient_Psychiatric_and_RTC.pdf
... denied first at the acute level of care. • Should the provider choose to not appeal they may request these dates of service at a lower level ...
Terms matched: 1  -  Score: 20  -  07 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Quick_Tip_Guide_Inpatient_Psychiatric_and_RTC.pdf
364. NV_BillingGuidelines_PT28_20210526.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 44  -  01 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20210526.pdf
365. NV_BillingGuidelines_PT28_20210331.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 44  -  01 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20210331.pdf
366. NV_BillingGuidelines_PT29_online_20191125.pdf
... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 36  -  01 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20191125.pdf
367. Antipsychotics_Atypical_2021-06.pdf
... 2021. • Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. www.uptodate.com/ . Updated April 11, 2021. ...
Terms matched: 1  -  Score: 10  -  06 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Antipsychotics_Atypical_2021-06.pdf
368. NMO-3430A_Instructions.pdf
... agency as listed below. 5. Any person who fills out the form must choose only one event, not multiple events. The description of the event can ...
Terms matched: 1  -  Score: 14  -  06 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NMO-3430A_Instructions.pdf
369. NV_BillingGuidelines_PT55_20210315.pdf
... provider. Note: PT 55 procedure codes are carved out of Managed Care (MCO) and services are paid out of FFS. (T2020 and T2017, ...
Terms matched: 1  -  Score: 20  -  12 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT55_20210315.pdf
370. Health_Plan_of_Nevada_DUR_Binder_April_2021.pdf
... Drug Use Review Board Meeting APRIL 22, 2021 2021 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 94  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_April_2021.pdf
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