Nevada Medicaid and Nevada Check Up News (First 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

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

Nevada Medicaid/Nevada Check Up Fee For Service providers may save valuable time, build staff efficiency and enhance the safety of the prescribing process by establishing an electronic prescribing connection with pharmacies. Electronic prescribing, also referred to as e-prescribing, is the exchange of prescription information through computer-to-computer connections, instead of issuing prescriptions by paper, fax or phone. The computer-to-computer process is safer and more secure for recipients, prescribers and pharmacies, because paper faxes are eliminated.

An additional money-saving benefit for providers who use e-prescribing is that they are exempt from the tamper-resistant prescription pad requirements in effect for all written, non-electronic prescriptions for Medicaid Fee For Service outpatient drugs.

Nevada Medicaid/Nevada Check Up providers who use electronic prescribing now have access to data that will assist them in managing prescriptions for recipients more efficiently. Information the Division of Health Care Financing and Policy (DHCFP) and Nevada Medicaid have made available through prescribers’ practice management software vendors includes:

  • Recipient pharmacy claims history
  • Eligibility data
  • Indication of the need for prior authorization

The recipient data provided by DHCFP and Nevada Medicaid to software vendors is transmitted via technologies that are compliant with Health Insurance Portability and Accountability Act (HIPAA) security requirements.

Contact your practice management software vendor to enable your system for Nevada Medicaid/Nevada Check Up e-prescriptions. The functionality of your system is determined by your software vendor.

The following websites offer detailed information and assistance to prescribers and pharmacies:
Visit this website to complete a short practice compatibility assessment to determine if your practice has the ability to establish a direct electronic connection with pharmacy computers.
Visit the SureScripts® website for steps prescribers and pharmacies can take to get set up to send and receive e-prescriptions (at this website select “Pharmacies” or “Physicians” from the menu bar). This website also contains support information, best practices, communication tools, a list of activated pharmacies in your area and other resources. SureScripts operates the Pharmacy Health Information Exchange™, which facilitates the secure electronic transmission of prescription information between physicians and pharmacists through the provider’s practice management software.

Resources for additional information:

Call SureScripts at 1-866-RxReady or 1-866-797-3239 for questions about electronic prescribing connectivity.

Review the Frequently Asked Questions for answers to a variety of electronic prescribing issues.


  • All practice management software vendors who provide e-prescribing software in Nevada must be certified by the Nevada State Board of Pharmacy.
  • Prescribers are responsible for assuring the confidentiality and security of the recipient’s information through e-prescribing.