Nevada Medicaid and Nevada Check Up News (Second Quarter 2026 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 4 p.m. Pacific Time on Sunday, October 11, 2026, through 3 a.m. Pacific Time on Monday, October 12, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • Provider Flex
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2026 Professional Claims. See Web Announcement 4009.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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 https://NevadaMedicaid.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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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31. NV_Flex_User_Guide_Group.pdf
... not link individuals are required to select “Biller and Performerâ€13. Choose the option that most closely describes the entity you are enrolling in. Group ...
Terms matched: 1  -  Score: 14  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
32. NV_Flex_User_Guide_Individual.pdf
... Filesâ€button. 2. Click the “Select Filesâ€button and choose a PDF to attach. • Attachments must be in PDF format ...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
33. Benefit_Enrollment_and_Maintenance_(834).pdf
... are performed, then no enrollment file will be generated and made available to the MCO. Monthly Files • Monthly files include members which have a maintenance ...
Terms matched: 1  -  Score: 84  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
34. NV_Billing_General_20250801.pdf
... 2025 30 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: 199  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
35. NV_EVS_User_Manual_Ch2.pdf
... the Nevada Medicaid and Nevada Check Up program as well as Managed Care Organizations (MCO) and Third Party Liability (TPL) . The eligibility request is sent ...
Terms matched: 1  -  Score: 123  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch2.pdf
36. NV_BillingGuidelines_PT12_online_20250804.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request PA from and submit claims to the MCO. For recipients ...
Terms matched: 1  -  Score: 38  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20250804.pdf
37. NV_BillingGuidelines_PT11_online_050625.pdf
... 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  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_050625.pdf
38. NV_BillingGuidelines_PT12.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request PA from and submit claims to the MCO. For recipients ...
Terms matched: 1  -  Score: 25  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12.pdf
39. NV_BillingGuidelines_PT17_Specialty_181_20250414.pdf
... to pay FQHCs providing services under a contract with a Medicaid Managed Care Organization (MCO; also known as a Managed Care Entity [MCE]) supplemental payments ...
Terms matched: 1  -  Score: 23  -  11 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20250414.pdf
40. NV_BillingGuidelines_PT43_20250724.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: 47  -  04 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250724.pdf
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