Nevada Medicaid COVID-19

Nevada Health Response

Due to scheduled system maintenance, the following functionalities will be unavailable from 7 a.m. to 9 a.m. Pacific Time Sunday, September 26, 2021:

• Trading Partner File Transfer (EDI/SFTP)
• Business Partner File Transfer (EDI/SFTP)

The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, September 26, 2021, 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

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 dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.