Nevada Medicaid and Nevada Check Up News (Third Quarter 2025 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

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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 dhcfp.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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... HMO Plan Nevada Medicaid Health Maintenance Organization (HMO)/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  26 Aug 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3424_20240826.pdf
... claims for orthodontia must be submitted to the Nevada Medicaid fiscal agent, not the MCO. Please see the ADA Claim Form Instructions and the Orthodontic Medical Necessity ( ...
Terms matched: 1  -  Score: 20  -  10 Apr 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20190201.pdf
... claim to the appropriate Nevada by HMO Plan Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  23 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3448_20240923.pdf
... claims for orthodontia must be submitted to the Nevada Medicaid fiscal agent, not the MCO. Please see the ADA Claim Form Instructions and the Orthodontic Medical Necessity ( ...
Terms matched: 1  -  Score: 20  -  09 Oct 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20181010.pdf
... claim to the appropriate by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  21 Oct 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3465_20241021.pdf
... claim to the appropriate by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  24 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3538_20250124.pdf
... to be applied to the document and includes the necessary information. If a provider chooses to use electronic signatures, that provider is responsible for the technical support of ...
Terms matched: 1  -  Score: 20  -  04 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3547_20250204.pdf
... claim to the appropriate by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the EVS by reviewing ...
Terms matched: 1  -  Score: 20  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3559_20250220.pdf
... beginning Jan. 1, 2011, but may start the process immediately if they choose to do so. Re-enrollment under the new procedures must be completed by Oct ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_355_20100930.pdf
... to the appropriate Covered by HMO Plan Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Client eligibility can be verified within the PWP by reviewing ...
Terms matched: 1  -  Score: 20  -  28 Mar 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3593_20250328.pdf
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