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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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.

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381. web_announcement_2120_20200303.pdf
... FFS recipients and does NOT apply to recipients enrolled in a Managed Care Organization (MCO) (Health Plan of Nevada, Anthem Blue Cross and Blue Shield Healthcare ...
Terms matched: 1  -  Score: 23  -  03 Mar 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2120_20200303.pdf
382. Diabetic_Supply_Webinar_Presentation.pdf
... €¢ FFS only â€" does not apply to recipients enrolled in an MCO • Preferred Diabetic Products: Omnipod, Dexcom G6 and FreeStyle Libre ...
Terms matched: 1  -  Score: 16  -  27 Mar 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Diabetic_Supply_Webinar_Presentation.pdf
383. SilverSummit_DUR_Binder_April_2020.pdf
... Utilization 36 Standard Reports 41 Anti-Migraine Medications CGRP's 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: 113  -  06 Apr 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_April_2020.pdf
384. Anthem_DUR_Binder_April_2020.pdf
... Presentation Presented to NV DUR Board on April 30, 2020 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 83  -  06 Apr 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2020.pdf
385. FFS_DUR_Binder_2020-04_v2.pdf
... People- It's Who We Are And What We Do 13 Managed Care Organizations (MCO) Thomas Beranek â€" Silver Summit Health Plan Ryan Bitton †...
Terms matched: 1  -  Score: 14  -  08 Apr 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_2020-04_v2.pdf
386. NV_Billing_General_20191121.pdf
... 2019 34 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 198  -  13 Apr 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20191121.pdf
387. web_announcement_Volume 17, Issue 1_20200416.pdf
... some of the published web announcements: Choose Service Location Web Announcement 2137: Pharmacy ... Organization and Resolutions and/or (MCO) websites. The Providers section includes ...
Terms matched: 2  -  Score: 35  -  16 Apr 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2017,%20Issue%201_20200416.pdf
388. web_announcement_2187_20200506.pdf
... PT) 32 ambulance providers, were carved out of the Managed Care Organization (MCO) contracts and are now billed as Fee-for-Service Medicaid. Some GEMT claims for ...
Terms matched: 1  -  Score: 42  -  06 May 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2187_20200506.pdf
389. Multiple_Sclerosis_Agents_2020-06.pdf
... lesions assessed at least annually) . (Strong) o For active RRMS, choosing among the wide range of available drugs from the modestly to highly effective will ...
Terms matched: 1  -  Score: 23  -  07 May 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Multiple_Sclerosis_Agents_2020-06.pdf
390. Atypical_Antipsychotics_2020-06.pdf
... 2020. • Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. 2020[b ] . www.uptodate.com/ . Accessed ...
Terms matched: 1  -  Score: 10  -  07 May 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Atypical_Antipsychotics_2020-06.pdf
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