Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2021 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]


Nevada Medicaid COVID-19

Nevada Health Response

Known Modernization System Issues-Click HERE

Paper claims are no longer accepted by Nevada Medicaid. Please refer to Web Announcement 1733 and Web Announcement 1829 for additional information.

Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2021 Claims. Web Announcement 2472.

Top Prior Authorization Denial Reasons for the First Quarter of 2021. See Web Announcement 2505.

Top 10 Enrollment Return Reasons and Resolutions for First Quarter 2021 Submissions. See Web Announcement 2501.

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 and the Billing Guide for your provider type at

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

8:00PM - 12:00AM

General Information

Customer Service Center
Claim inquiries and general information
Mailing Address:
Nevada Medicaid
Customer Service
P.O. Box 30042
Reno, NV 89520-3042
Phone: (877) 638-3472

Nevada Medicaid Central Office
State policy inquiries and Fair Hearing requests
Mailing Address:
1100 East William St.
Suite 102
Carson City, NV 89701
Phone: (877) 638-3472 and (775) 684-3600

Medicaid Recipient Customer Service
Las Vegas District Office: (702) 668-4200
Reno District Office: (775) 687-1900
All other areas: (866) 569-1746

Automated Response System (ARS)
Recipient eligibility, recent payments, claim status, and prior authorization information via phone
Phone: (800) 942-6511

Electronic Verification System (EVS)
Recipient eligibility, claim status, prior authorization status, provider payments

Note: For EVS, there can only be one provider administrator for each NPI/FEIN/zip code. The provider administrator must register as a “Provider” and will be responsible for creating delegates for that provider. If you do not know who is the provider administrator is in your office, call the Customer Service Center at (877) 638-3472.

Web Sites

Nevada Medicaid Web Site
Web announcements, billing manual, billing guidelines, forms, pharmacy information

DHCFP Web Site
Medicaid Services Manual, rates, policy updates, public notices

Provider Training

Mailing Address:
Nevada Medicaid
Provider Training
P.O. Box 30042
Reno NV 89520-3042

Electronic Billing

Mailing Address:
Nevada Medicaid
EDI Coordinator
P.O. Box 30042
Reno, NV 89520-3042
Phone: (877) 638-3472 (select option for "Electronic Billing")

Managed Care Organizations (MCOs)

The Nevada Medicaid and Nevada Check Up contracted Managed Care Organizations (MCOs) are Anthem Blue Cross and Blue Shield Healthcare Solutions, Health Plan of Nevada and SilverSummit Healthplan. LIBERTY Dental Plan of Nevada is the Dental Benefits Administrator (DBA).

Anthem Blue Cross and Blue Shield Healthcare Solutions
Provider Contracting
Phone: (702) 228-1308
Fax: (866) 495-8711

Provider Customer Service
(for eligibility, claims and pre-certification)
Phone: (844) 396-2330
Fax: (866) 495-8711 (except pre-certification)

Fax: (800) 964-3627 (For all other pre-certification requests, including ALL elective inpatient or outpatient services)
Fax: (866) 920-8362 (For durable medical equipment (DME), outpatient rehabilitation (PT/OT/ST), pain management, home care, home infusion, hyperbaric treatment, and wound care)

Provider Self-Service Website

Claims Address
Anthem Blue Cross and Blue Shield Healthcare Solutions
Attn: Nevada Claims
P.O. Box 61010
Virginia Beach, VA 23466-1010

Anthem Nevada Member Services
Phone: (844) 396-2329

Health Plan of Nevada (HPN)
Provider Relations and Provider Contracting
(702) 242-7088 or (800) 745-7065


Member Services
Phone: (800) 962-8074
Fax: (702) 240-6281

Claims Address
Health Plan of Nevada
P.O. Box 15645
Las Vegas, NV 89114

EDI Claims Submission Clearinghouse:
1755 Telstar Drive #400
Colorado Springs, CO 80920

Payor ID’s:
Claims – Payor ID 76342
Encounter Data – Payor ID 76343

LIBERTY Dental Plan of Nevada
Provider Relations and Provider Contracting
Phone: (888) 700-0643

Member Services
Phone: (866) 609-0418

Claims Address
LIBERTY Dental Plan of Nevada
Attn: Claims
P.O. Box 401086
Las Vegas, NV 89140

Payor ID: CX083

SilverSummit Healthplan
Provider Contracting
(844) 366-2880

Provider Inquiry Telephone Numbers
Medical/Behavioral Health: (844) 366-2880
Pharmacy: (844) 366-2880
Pharmacy (Prior Authorization): (855) 565-9520
Vision: (855) 896-8572

Claims Addresses
Medical/Behavioral Health:
P.O. Box 5090
Farmington, MO 63640

5 River Park Place E, Suite 210:
Fresno, CA 93720

Attn: Claims Processing
PO Box 7548
Rocky Mount, NC 27804

Fax Numbers
Prior Authorization Requests: Medical: (844) 367-7022 Behavioral Health: (855) 868-4940 Pharmacy: (866) 399-0929
Medical Records (for nurse use) (844) 518-7889
Admissions Census/Facesheets (844) 868-7399
Concurrent Review (844) 755-1370
Case Management (844) 851-1023
Medical Management General (844) 367-7015
Nevada Quality Improvement (855) 565-9517
Nevada Grievance and Appeals (855) 742-0125

Provider Enrollment

Mailing Address:
Nevada Medicaid
Provider Enrollment
PO Box 30042
Reno, NV 89520-3042
Phone: (877) 638-3472 (select option for "Provider Enrollment")

Prior Authorization

Prior Authorization
Phone: (800) 525-2395

Prior Authorization for Dental

Nevada Medicaid
"Dental PA"
P.O. Box 30042
Reno, NV 89520-3042
Phone: (800) 525-2395

Prior Authorization for All Other Service Types (except Pharmacy)
Phone: (800) 525-2395


Customer Service Center
Pharmacy prior authorization requests
Phone: (855) 455-3311
Fax: (855) 455-3303

Technical Call Center
General pharmacy inquiries
Phone: (866) 244-8554

Pharmacy Web PA
Submit prior authorization requests online for prescription drugs. Select "Pharmacy Web PA Login" from the "Pharmacy" menu on this web site. This will take you to the EVS Login. After login, prescribers will see a link for Pharmacy PA.

Public Hearings

Providers are welcome to attend public hearings and voice their opinion on policy changes. Call the number below to receive electronic or written notices of scheduled public hearings.

Phone: (775) 684-3681


Phone: (800) 525-2395
Fax: (855) 709-6847

Third Party Liability (TPL) Identification and Recovery

If you believe a recipient's private insurance or Medicare Replacement records are incorrect, please contact Health Management Systems, Inc. (HMS) at:

Mailing Address:
HMS - NV Third Party Liability
P.O. Box 12610
Reno, NV 89510

Phone: (775) 335-1040
Toll Free: (855) 528-2596
Fax: (972) 284-5959
NOTE: When emailing HMS, “escalation” should be included in the subject line and the email request must include Recipient Name, Date of Birth (DOB), Medicaid ID, and commercial policy information.

If you believe a recipient's Medicare record is incorrect, please contact the DHCFP at:

Electronic Health Records (EHR) Incentive Program

Customer Service Center
CGI Business Services
Phone: (888) 639-3452