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]

Featured Links

DHCFP EVV

Authorization Criteria

DHCFP Home

EDI Information

PWP User Manual

Provider Flex

Online Provider Enrollment

Provider Login (PWP)

Prior Authorization

Search Fee Schedule

Search Providers

Claims

Trading Partner

Self-Paced Training Videos

Notifications

NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Monday, November 3, 2025, for maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • 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)

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 September 2025 Professional Claims. See Web Announcement 3745.

Top Prior Authorization Denial Reasons for the Second Quarter of 2025. See Web Announcement 3712.

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.

Provider Links

DHCFP EVV

Billing Information

Forms

Provider Enrollment

Provider Newsletters

Provider Training

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


Billing Information

Effective February 1, 2019, all providers will be required to submit their claims electronically (using Trading Partners or Direct Data Entry [DDE]), as paper claims submission will no longer be accepted.

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Web Announcement 1711]


FAQs: National Correct Coding Initiative (NCCI) Claim Review Edits [Review Now]

Clinical Claim Editor FAQs Updated December 5, 2011 [Review Now]

Submitting Claims with Other Insurance (Third Party Liability) Frequently Asked Questions (FAQs) [Review Now]


COVID-19 Billing Guides Archives Click here


Remittance Advice Reference Material
Title Last Update
Claim Error/EOB/ANSI Code Crosswalk 10/07/2025
Accounts Receivable Financial Reason Codes 10/09/2020

Billing Manual
For Archives Click here

Title File Size Last Update
Billing Manual 2 MB 10/17/2025

Billing Guidelines (by Provider Type)
For Archives Click here

Provider Type Title Last Update
10 Outpatient Surgery, Hospital Based | Rates 01/29/25
11 Hospital, Inpatient 08/27/25
12 Hospital, Outpatient 08/27/25
13 Psychiatric Hospital, Inpatient 06/06/25
14 Behavioral Health Outpatient Treatment | Outpatient Mental Health Treatment Plan Fact Sheet 03/05/25
15 Registered Dietitian 12/16/19
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 11/25/19
17 Special Clinics 08/11/25
17 (Spec. 169) Special Clinics: Freestanding Birthing Centers 10/12/21
17 (Spec. 179) Special Clinics: School Based Health Centers (SBHC) 01/25/19
17 (Spec. 181) Special Clinics: Federally Qualified Health Centers (FQHC) 08/11/25
17 (Spec. 188) Special Clinics: Certified Community Behavioral Health Center (CCBHC) | CCBHC Allowable Services | FQHC-CCBHC Allowable Services 12/06/23
19 Nursing Facility 08/24/23
20 Physician, M.D., Osteopath, D.O. 10/13/25
20 (Spec. 699) Children’s Cancer and Rare Diseases Clinic 07/17/24
21 Podiatrist 01/29/25
22 Dentist | Attachment A: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements | Attachment B: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements for Dental Services for the Waiver for Individuals with Intellectual and Developmental Disabilities 10/06/25
23 Hearing Aid Dispenser & Related Supplies 12/06/24
24 Advanced Practice Registered Nurses 10/13/25
25 Optometrist 12/18/24
26 Psychologist 10/13/25
27 Radiology and Non-invasive Diagnostic Centers 02/25/20
28 Pharmacy: Billing Manual n/a
29 Home Health Agency and Private Duty Nursing Services 07/09/25
30 Personal Care Services - Provider Agency 01/31/19
32 (Spec. 249) Community Paramedicine 08/04/25
32 (Spec. 932) Ambulance, Air or Ground 12/07/21
33 Durable Medical Equipment (DME), Disposable, Prosthetics 06/23/25
34 Therapy 11/21/23
35 (Spec. 987) Non-Emergency Secure Behavioral Health Transports 07/19/21
36 Chiropractor 10/28/25
38 Waiver for Individuals with Intellectual and Developmental Disabilities | Attachment A: Variable Services Procedure Codes for Waiver for Individuals with Intellectual and Developmental Disabilities 12/27/24
39 Adult Day Health Care 03/09/20
41 Optician, Optical Business 12/18/24
43 Laboratory, Pathology Clinical 08/04/25
44 Swing-bed, Acute Hospital 11/25/19
45 End Stage Renal Disease (ESRD) Facility 02/03/21
46 Ambulatory Surgical Centers 01/29/25
47 Indian Health Services (IHS) and Tribal Clinics 04/22/25
48 Home and Community Based Waiver for the Frail Elderly 06/22/23
51 Indian Health Service Hospital, Inpatient (Tribal) 12/02/19
52 Indian Health Service Hospital, Outpatient (Tribal) 12/02/19
54 Targeted Case Management 06/17/20
55 (Spec.315) Day Habilitation 08/01/24
55 (Spec.316) Residential Habilitation 08/01/24
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 12/03/19
57 Home and Community Based Waiver for the Frail Elderly in Residential Facilities for Groups 01/25/21
58 Home and Community Based Waiver for Persons with Physical Disabilities 12/12/22
59 Home and Community Based Waiver for the Frail Elderly in an Assisted Living Facility 05/24/23
60 School Health Services (SHS) 08/28/24
63 Psychiatric Residential Treatment Facility (PRTF) 01/20/22
64 Hospice 01/16/25
65 Hospice, Long Term Care 01/26/23
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Private 11/25/19
72 Nurse Anesthetist 12/05/11
74 Nurse Midwife 08/21/25
75 Critical Access Hospital (CAH), Inpatient 05/06/25
76 Audiologist 12/06/24
77 Physician's Assistant 10/13/25
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 12/02/19
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 12/02/19
81 Hospital Based ESRD Provider 02/03/21
82 Behavioral Health Rehabilitative Treatment 04/09/24
83 Personal Care Services - Intermediary Service Organization 01/31/19
85 Applied Behavior Analysis (ABA) 03/04/25
86 Specialized Foster Care | Specialized Foster Care Needs Based Eligibility Checklist 07/17/25
87 (Spec. 031) Designated Mobile Crisis Team (DMCT) 09/03/24
87 (Spec. 032) Designated Mobile Crisis Team Attached to a CCBHC 09/03/24
87 (Spec. 250) Crisis Stabilization Center 09/03/24
89 Community Health Workers 09/10/25
90 Doula Services 08/26/25
91 Pharmacist 08/16/24
93 (Spec. 704) Residential Substance Use Treatment in an Institution for Mental Disease 02/19/25
93 (Spec. 707) Substance Use Treatment Clinic 07/21/25
93 (Spec. 708) Opioid Treatment Program 07/21/25
95 Home and Community Based Waiver for Structured Family Caregiving 04/11/25
96 Rural Emergency Hospital (REH), Outpatient 08/04/25
97 Peer Support Services 10/01/25

Billing Instructions (by Service Type)
Title Last Update
Anesthesia 04/21/22
Emergency Medicaid Only (EMO) 02/07/23
Justice Involved Reentry Initiative 01/03/25
Medication-Assisted Treatment (MAT) Services for Opioid Dependence 07/25/24
Preventive Services 05/04/20
Sterilization and Abortion Policy 07/11/25
Telehealth 02/22/23