Nevada Medicaid and Nevada Check Up News (Second Quarter 2022 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

The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, August 7, 2022, for scheduled maintenance:

  • Secure Provider Web Portal (Electronic Verification System – EVS)
  • Online Provider Enrollment (OPE)
  • Online Provider Claim Appeals
  • Online Prior Authorization (PA) system
  • Online Claims Submission
  • Audio Response System (ARS) (800-942-6511)
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

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

Effective January 1, 2022, Medicaid enrollees may be switched to one of four MCOs. Enrollees that are switched will have 90 days to choose a different MCO.

If you need to change your assigned MCO, complete the Nevada Medicaid And Nevada Check Up Managed Care Program Special MCO Assignment Change form. Return the form to Nevada Medicaid, Attn: MCO Changes, P.O. Box 30042, Reno, NV 89520. If you do not change your MCO by 03/31/2022, you will not be able to change it until the next annual open enrollment period beginning October 1, 2022 which will be effective no sooner than January 1, 2023.

For details on open enrollment, contact your local Medicaid District Office at the following numbers: Northern Nevada (775) 687-1900 or Southern Nevada (702) 668-4200.

Medicaid Member News: Nevada Medicaid sends notifications over ListServ direct to your email regarding news, initiatives and public meetings. Click to subscribe.

FAQs: Managed Care Enrollment [Review Now]

To review Managed Care Organization Value Added Services Comparison Charts, visit

Nevada Medicaid and Nevada Check Up contracted Managed Care Organizations (MCOs) Contact Information:

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, Molina Healthcare of Nevada and SilverSummit Healthplan. LIBERTY Dental Plan of Nevada is the Dental Benefits Administrator (DBA).

Anthem Blue Cross and Blue Shield Healthcare Solutions

Anthem Nevada Member Services

Phone: (844) 396-2329


Health Plan of Nevada (HPN)

Health Plan of Nevada (HPN) Member Services

Phone: (800) 962-8074

Fax: (702) 240-6281


LIBERTY Dental Plan of Nevada

Liberty Dental Plan of Nevada Member Services

Phone: (866) 609-0418


Molina Healthcare of Nevada

Molina Healthcare of Nevada Member Services

Phone: (833) 685-2102


SilverSummit Healthplan

SilverSummit Healthplan Member Services

Phone: (844) 366-2880