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]

Notifications

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.

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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... Options This section describes the connectivity options from which a Trading Partner will need to choose for the submission of transactions. Nevada Medicaid supports multiple methods for exchanging electronic ...
Terms matched: 1  -  Score: 68  -  20 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EDI_Trading_Partner_User_Guide.pdf
... services. Nevada Check Up recipients are not disenrolled from a Managed Care Organization (MCO) when they receive hospice services. Although Nevada Check Up recipients receiving hospice ...
Terms matched: 1  -  Score: 64  -  26 Jan 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT65_online_20210421.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim) . The ...
Terms matched: 1  -  Score: 129  -  06 Feb 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NCPDP_Encounter_Companion_Guide.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  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3023_20230302.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  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20220202.pdf
... for Nevada Medicaid FFS recipients. Below are the dates and times from which to choose: Date Time Registration link Tuesday, June 13, 2023 8 a.m. ...
Terms matched: 1  -  Score: 20  -  30 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3041_20230330.pdf
... menu) . Managed Care Hospitals may provide services to Medicaid Managed Care Organization (MCO) recipients but must request reimbursement from the MCO. There are no carve-outs ...
Terms matched: 1  -  Score: 36  -  30 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10_20090801.pdf
... the appropriate Neva- Covered by HMO da Medicaid HMO/Managed Care Organization (MCO) for Plan processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 35  -  31 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2020%20Issue%201_20230331.pdf
... the appropriate Neva- Covered by HMO da Medicaid HMO/Managed Care Organization (MCO) for Plan processing. Provider may find out which MCO the recipient belongs ...
Terms matched: 1  -  Score: 35  -  03 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2023-03.pdf
... completed upon the change of supervisor) . 3. The FQHC will notify each MCO of onboarded and dropped CHWs employed within the clinic using the preferred method of ...
Terms matched: 1  -  Score: 69  -  07 Apr 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3048_20230407.pdf
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