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]

Notifications


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 14 and 82:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 9, 2025 – June 16, 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 March 2025 Professional Claims. See Web Announcement 3616.

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.

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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... lesions assessed at least annually) . (Strong) o For active RRMS, choosing among the wide range of available drugs from the modestly effective to the highly ...
Terms matched: 1  -  Score: 23  -  11 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Multiple_Sclerosis_Agents_2019-1211.pdf
... Pharmaceuticals; November 2017. ï ‚ Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. www.uptodate.com. Updated November 2, 2017 ...
Terms matched: 1  -  Score: 10  -  11 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anticonvulsants_2019-1211.pdf
... Fee-For-Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 31  -  16 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_020119.pdf
... Presentation Presented to NV DUR Board on January 23, 2020 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 88  -  17 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Jan_2020.pdf
... Standard DUR Reports - 29 Multiple Sclerosis Agents Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 72  -  17 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_Jan%202020.pdf
... Drug Use Review Board Meeting JANUARY 23, 2020 2020 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 66  -  17 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HPN_DUR_Binder_Jan_2020.pdf
... the DUR is the third from the top is ingredient duplication. We continue to choose a new topic for RetroDUR every quarter and send out letters each month. ...
Terms matched: 1  -  Score: 55  -  17 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_Jan_2020.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: 41  -  26 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20190131.pdf
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 36  -  30 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46_20190131.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: 126  -  06 Jan 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT63_20190429.pdf
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