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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51. web_announcement_1389_20170605.pdf
... ) form. Remind your patients to choose an MCO during Medicaid Managed Care Open ... by the current Managed Care Organizations (MCO) . As of July 1, ...
Terms matched: 2  -  Score: 335  -  29 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1389_20170605.pdf
52. newsletter_v2i2.pdf
... existing, HIPAA-compliant business software. When choosing a clearinghouse, remember that Payerpath is ... to as a Managed Care Organization (MCO), are: • ...
Terms matched: 2  -  Score: 333  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v2i2.pdf
53. PWP_PA_Training_2017-07.pdf
... authorized to access. â"€ Choose the Functions you want the delegate to ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for- Service (FFS ...
Terms matched: 2  -  Score: 329  -  31 Oct 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PWP_PA_Training_2017-07.pdf
54. NV_Billing_General_online_2008-12-04_to_2009-01-30.pdf
... Managed Care .... 16 Fee For Service.... 16 Managed Care .... 16 MCO Contact Information .... 16 Health Plan of Nevada (HPN) .... ...
Terms matched: 1  -  Score: 324  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2008-12-04_to_2009-01-30.pdf
55. Provider_Revalidation_and_Change_(Individual).pdf
... providers. The user will need to choose the correct provider and click on the ... ) recipients, Managed Care Organization (MCO) recipients or both FFS and MCO ...
Terms matched: 2  -  Score: 320  -  25 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Revalidation_and_Change_(Individual).pdf
56. PWP_PCS_Training_2017-07.pdf
... authorized to access. â"€ Choose the Functions you want the delegate to ... Eligibility Changes from Managed Care Organization (MCO) to Fee-for- Service (FFS ...
Terms matched: 2  -  Score: 320  -  19 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PWP_PCS_Training_2017-07.pdf
57. Provider_Revalidation_and_Change_(Group).pdf
... providers. The user will need to choose the correct provider and click on the ... ) recipients, Managed Care Organization (MCO) recipients or both FFS and MCO ...
Terms matched: 2  -  Score: 320  -  25 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Revalidation_and_Change_(Group).pdf
58. NV_Billing_General_online_2008-08-08_to_2008-12-04.pdf
... Managed Care .... 18 Fee For Service.... 18 Managed Care .... 18 MCO Contact Information .... 18 Health Plan of Nevada (HPN) .... ...
Terms matched: 1  -  Score: 320  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2008-08-08_to_2008-12-04.pdf
59. COVID-19_General_Billing_Guide.pdf
... in Nevada WebIZ, unless the patient chooses to opt-out of inclusion in the system ... €" Medicaid Fee-For-Service • MCO â€" Managed Care Organization â ...
Terms matched: 2  -  Score: 318  -  21 Dec 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/COVID-19_General_Billing_Guide.pdf
60. NV_Provider_Enrollment_Information_Booklet.pdf
... , procuring a vendor that providers can choose to utilize, but also allows providers ... program-integrity/index.html Managed Care Organization (MCO) Network Providers: • ...
Terms matched: 2  -  Score: 316  -  14 Mar 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Provider_Enrollment_Information_Booklet.pdf
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