Nevada Medicaid and Nevada Check Up News (First Quarter 2024 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

Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Please be advised that claims must be submitted before noon Pacific Time on Fridays to be included in the following weeks’ remittance advice.

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

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 May 2024 Professional Claims. See Web Announcement 3382.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2023. See Web Announcement 3280.

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

Thank you for your interest in the Nevada Medicaid and Nevada Check Up Program. This page contains all of the information and forms you will need to become a Nevada Medicaid provider. If you have any questions, please contact the Provider Enrollment Unit at (877) 638-3472 from 8 a.m. to 5 p.m. Pacific Time Monday through Friday.


All providers are required to submit their provider enrollment or re-enrollment applications electronically via the Online Provider Enrollment (OPE) tool at https://www.medicaid.nv.gov/hcp42/provider/Home/tabid/477/Default.aspx. Paper applications are not accepted.


All enrollment documents including attachments require an original signature from the provider or an authorized representative (use dark blue or black ink).


Required Enrollment Documents
Online Provider Enrollment User Manual
Revalidation Report
  • Provider Revalidation Report: The Nevada Medicaid Provider Revalidation Report lists each provider and the date their next revalidation is due. To avoid contract termination, your revalidation application must be processed and approved prior to the revalidation due date. Providers can start their revalidation process up to a year in advance. Revalidations submitted prior to one year in advance will be returned.
Provider Enrollment and Revalidation Instruction Materials
Date Topic
April 2023 Information for Individuals Preparing to Enroll with Nevada Medicaid (Quick Reference Guide)
April 2023 Information for Groups Preparing to Enroll with Nevada Medicaid (Quick Reference Guide)
January 2023 Ordering, Prescribing and Referring Provider Enrollment Frequently Asked Questions (FAQs)
- Provider Enrollment Training Courses – Register Here
- Provider Enrollment Instructional Videos – View Here
Hospital Presumptive Eligibility Documents
  • Web Announcement 3306: Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines for 2024
  • Web Announcement 1008: Attention ALL Hospital Presumptive Eligibility Providers: Guidance Policy Available
  • Web Announcement 861 with Training Schedule: Implementation of Hospital Presumptive Eligibility Option for Acute Care Hospitals (Provider Types 11 and 75)
  • Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum: Qualified hospitals must complete and submit the Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum.
  • Hospital Presumptive Eligibility Training Sign-Up Sheet: Complete this form listing the hospital employees that will be attending the mandatory training for Presumptive Eligibility. You will be notified by the DWSS in regards to the training dates and times. Keep in mind that each employee making PE determinations MUST be trained by DWSS and complete a competency examination prior to making ANY determinations.
Pregnancy Presumptive Eligibility Documents
Changes to Provider Information

Changes to any information presented on your enrollment documents must be reported to Nevada Medicaid within five business days.


  • To complete changes online, please login to the Secure Web Portal, and choose “Revalidate-Update Provider”.
  • To report a change in business ownership, submit a completed Provider Enrollment Application.
Provider License Updates and Voluntary Terminations Only