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]

Notifications

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.

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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... Managed Care .... 18 Fee For Service.... 18 Managed Care .... 18 MCO Contact Information .... 18 Health Plan of Nevada (HPN) .... ...
Terms matched: 1  -  Score: 315  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2007-08-09_to_2008-08-08.pdf
... than welcome to do whatever the Board chooses to do. You could do the ... and not to be confused with an MCO or Managed Care Organization. We serve ...
Terms matched: 2  -  Score: 311  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2015_09.pdf
... ) of the provider’s choosing. Rural Emergency • State ... the group. Managed Care Organization (MCO) Network Providers: • ...
Terms matched: 2  -  Score: 311  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... Type from the drop-down menu. Select Choose File and locate the appropriate document for ... ) recipients, Managed Care Organization (MCO) recipients or both FFS and MCO ...
Terms matched: 2  -  Score: 308  -  25 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_(Group).pdf
... Type from the drop-down menu. Select Choose File and locate the appropriate document for ... ) recipients, Managed Care Organization (MCO) recipients or both FFS and MCO ...
Terms matched: 2  -  Score: 308  -  25 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_(Individual).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: 308  -  16 Aug 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/COVID-19_Community-Based_Testing_Billing_Guide.pdf
... such patients in deciding which glucocorticoid to choose, when to initiate treatment, and ... ™s has been conducted. The MCO expansion was effective July 1, 2017 ...
Terms matched: 2  -  Score: 303  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2017-1011.pdf
... Eligibility ... 15 Sample Medicaid Card... 15 Fee For Service vs. Managed Care... 15 MCO Contact Information... 16 AMERIGROUP Community Care ... 16 Health Plan of Nevada (HPN ...
Terms matched: 1  -  Score: 303  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2009-01-30_to_2009-03-10.pdf
... Eligibility ... 14 Sample Medicaid Card... 14 Fee For Service vs. Managed Care... 14 MCO Contact Information... 15 Chapter 4: Prior and Retrospective Authorization ... 16 Introduction... 16 ...
Terms matched: 1  -  Score: 303  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2009-03-10_to_2009-08-26.pdf
... series of breakout sessions. Providers can choose from Medicaid the following breakout sessions when ... both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. ï ‚ You ...
Terms matched: 2  -  Score: 303  -  29 May 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2016-0930.pdf
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