Nevada Medicaid and Nevada Check Up News (Fourth 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]

Notifications

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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


Open enrollment occurs annually from October 1 through October 31. During open enrollment a Medicaid recipient can choose a new plan, and that choice will be effective on January 1 of each year.


Details on open enrollment can be found by downloading the "NVMedicaid" application found on the Apple Store, on Google Play, at the MDP weblink at https://mdp.medicaid.nv.gov/, on the DHCFP website at https://dhcfp.nv.gov/Members/BLU/MCOMain/, on the Medicaid website at https://www.medicaid.nv.gov/providers/enrollees/MCOinfo.aspx, or at your local Medicaid District Office at the following numbers: Northern Nevada (775) 687-1900 or Southern Nevada (702) 668-4200.


Sign up for Medicaid Member News: Nevada Medicaid sends notifications over ListServ direct to your email regarding news, initiatives and public meetings. Click https://dhcfp.nv.gov/Resources/NevadaMedicaidUpdate/MemberNewsListserv/ to subscribe.


FAQs for Managed Care Enrollment can be found here: https://dhcfp.nv.gov/Members/BLU/MCOMain/


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

Anthem Blue Cross and Blue Shield Healthcare Solutions
Phone: (844) 396-2329

CareSource
Phone: (833) 230-2058

Health Plan of Nevada (HPN)
Phone: (800) 962-8074

Molina Healthcare of Nevada
Phone: (833) 685-2102

SilverSummit Healthplan
Phone: (844) 366-2880