Nevada Medicaid and Nevada Check Up News (First 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 8 p.m. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • 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)
    • Known System Issues-Click HERE

    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

    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.

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441. PASRR_PWP_QRG.pdf
... to the PASRR application: 1) Click on your Admin tab. 2) Choose “Show Users for Name of Organizationâ€for Organization Profile. PASRR ...
Terms matched: 1  -  Score: 36  -  25 Jan 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PASRR_PWP_QRG.pdf
442. web_announcement_208_090308.pdf
... bill the additional charges at the rates listed on the applicable Managed Care Organization (MCO) or Medicaid Fee For Service (FFS) fee schedules. For example ...
Terms matched: 1  -  Score: 36  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_208_090308.pdf
443. web_announcement_2640_20211201.pdf
... Care Organizations (MCOs) . This change takes effect with the new Nevada Medicaid MCO contracts that begin January 1, 2022. The Division of Health Care Financing ...
Terms matched: 1  -  Score: 36  -  01 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2640_20211201.pdf
444. web_announcement_2871_20220815.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  15 Aug 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2871_20220815.pdf
445. web_announcement_2894_20220913.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  13 Sep 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2894_20220913.pdf
446. web_announcement_2929_20221025.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  25 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2929_20221025.pdf
447. web_announcement_2965_20221222.pdf
... claim to the appropriate Covered by HMO Nevada Medicaid HMO/Managed Care Organization (MCO) Plan for processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 36  -  22 Dec 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2965_20221222.pdf
448. web_announcement_2985_20230120.pdf
... claim to the by HMO Plan appropriate Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the recipient belongs to ...
Terms matched: 1  -  Score: 36  -  20 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2985_20230120.pdf
449. COVID-19_Dental_Billing_Guide.pdf
... Portal. Managed Care claims will be accepted by the applicable Managed Care Organization (MCO) and may be submitted on paper or electronically. Providers should access EVS ...
Terms matched: 1  -  Score: 35  -  16 Aug 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/COVID-19_Dental_Billing_Guide.pdf
450. NV_BillingGuidelines_PT56_20090801.pdf
... in a Managed per diem rate. General rate information is on Care Organization (MCO), request prior the DHCFP website at http://dhcfp.nv.gov. ...
Terms matched: 1  -  Score: 35  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56_20090801.pdf
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