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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471. SilverSummit_DUR_Binder_October_2021.pdf
... Reports â€" 26 2 Entresto Products 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: 88  -  28 Sep 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_October_2021.pdf
472. Opioid_Use_Disorder_Agents_2021-12.pdf
... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 16  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Use_Disorder_Agents_2021-12.pdf
473. Antipsychotics_Atypicals_2021-12.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  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Antipsychotics_Atypicals_2021-12.pdf
474. web_announcement_Volume%2018%20Issue%203_20211011.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%252018%2520Issue%25203_20211011.pdf
475. web_announcement_Volume%2018%20Issue%203_20211011_v2.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%252018%2520Issue%25203_20211011_v2.pdf
476. web_announcement_Volume_18_Issue_03_20211011_v2.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume_18_Issue_03_20211011_v2.pdf
477. web_announcement_Volume 18 Issue 3 v2_20211025.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  25 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2018%20Issue%203%20v2_20211025.pdf
478. E-Binder_SSSB_December_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: 21  -  04 Nov 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_December_2021.pdf
479. 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
480. NV_BillingGuidelines_PT28_20211119.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: 39  -  06 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20211119.pdf
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