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

Attention Pharmacies: Emergency Supply Policy

In an emergency situation, dispensing of up to a 96-hour supply of covered outpatient drugs that require prior authorization (PA) will be allowed. An approved PA (if required) will be necessary to get additional medication. If the prescriber is not available and the pharmacist feels the recipient needs to receive the prescribed drug, the pharmacist should contact the Clinical Call Center at (855) 455-3311 or the Technical Call Center at (866) 244-8554. OptumRx, the pharmacy benefit manager, may authorize a 96-hour emergency supply.

NOTE: An emergency situation is a situation that, in the judgment of the dispensing pharmacist, involves an immediate threat of severe adverse consequences to the recipient, or the continuation of immediate and severe adverse consequences to the recipient, if an outpatient drug is not dispensed when a prescription is submitted.

The Emergency Supply Policy is specified in the Medicaid Services Manual (MSM) Chapter 1200 Prescribed Drugs and the Pharmacy Billing Manual.

Pharmacy PA Forms

Pharmacy forms are for completion and submission by current Medicaid providers only. Use the forms below to request prior authorization. Attach documentation to support the request as needed. If you have questions, call Nevada Medicaid at (800) 525-2395.

Form Number Title
FA-59 Pharmacy Authorization
FA-61 Actemra® (tocilizumab)
FA-63 PDL Exception Prior Authorization
FA-64 Cox-II Prior Authorization
FA-65 Synagis® Prior Authorization
FA-66 Amevive® (alefacept)
FA-67 Growth Hormones For Recipients Under Age 21 Prior Authorization
FA-68 ADHD Treatment For Recipients Age 18 And Above
FA-69 ADHD Treatment For Recipients Under 18
FA-70A Psychotropic Agents for Children Age 0 to 5
FA-70B Psychotropic Agents for Children and Adolescents Ages 6 to 18
FA-71 Multiple Sclerosis – Ampyra® Prior Authorization
FA-72 Topical Androgen Agents
FA-73 Bunavail®, buprenorphine, buprenorphine-naloxone, Suboxone®, Zubsolv®
FA-74 Makena® (hydroxyprogesterone caproate injection)
FA-76 Cimzia® (certolizumab pegol)
FA-77 Targeted Immunomodulators
FA-78 Kineret® (anakinra)
FA-79 Orencia® (abatacept)
FA-80 Remicade® (infliximab)
FA-81 Simponi® (golimumab)
FA-82 Stelara® (ustekinumab)
FA-83 Monoclonal Antibody Agents
FA-84 Cesamet® (nabilone)
FA-85 Forteo® (teriparatide)
FA-86 Marinol® (dronabinol)
FA-87 Prolia® (denosumab)
FA-88 Opioid Quantity Limit
FA-89A Third Generation Cephalosporins and Fluoroquinolone
FA-89B Tedizolid (Sivextro®)
FA-89C Linezolid (Zyvox®)
FA-150 Compounded Medication
FA-151 Calcitonin Gene-Related Peptide (CGRP) Receptor Inhibitor Medications
FA-152 Epidiolex® (cannabidiol)
FA-153 Opioids Prescribed to Under Age 18
FA-154 Pulmonary Arterial Hypertension Agents
FA-155 Oral Oncology Agents
FA-156 Short-Acting Bronchodilator Quantity Limit
FA-157 Immunomodulator Drugs
FA-158 Xyosted™
FA-159 High Dollar Claim Prior Authorization Request Form
FA-160 Elidel® (pimecrolimus)
FA-161 Eucrisa®
FA-162 Protopic® (tacrolimus)
FA-163 Daliresp®
FA-164 Hematopoietic/Hematinic Agents
FA-165 Lidocaine Patch (Lidoderm®)
FA-166 Zolgensma®
FA-167 Hepatitis C Agents
FA-168 Multiple Sclerosis Agents
FA-169 Nayzilam®
FA-170 Sunosi®
FA-171 Zelnorm®
FA-172 Cystic Fibrosis Agents
FA-173 Sickle Cell Anemia Agents
FA-174 Wakix® (pitolisant)
FA-175 Toradol® (ketorolac tromethamine)
FA-176 Antihemophilia Agents
FA-177 Medications for Recipients on Hospice
FA-178 Lupron®
FA-179 Auvi-Q®
FA-180 Exondys 51™
FA-181 Spinraza®
FA-182 Somavert® (pegvisomant)
FA-183 Valtoco® (diazepam)
FA-184 Evenity® (romosozumab-aqqg)
FA-185 Tymlos® (abaloparatide)
FA-186 Doxepin Cream
FA-187 Orilissa® (elagolix)
FA-188 Oriahnn® (elagolix, estradiol and norethindrone)
FA-189 Zeposia® (ozanimod)
FA-190 Evrysdi® (risdiplam)
FA-191 Fintepla® (fenfluramine)
FA-192 Qutenza® (capsaicin)
FA-193 Vyondys 53® (golodirsen)
FA-194 Hereditary Angioedema (HAE) Agents
FA-195 Xywav® (oxybate salts)
FA-196 Ergot Derivatives (Dihydroergotamine)
FA-197 Viltepso®
FA-198 Aduhelm® (aducanumab)
FA-199 Entresto® (sacubitril-valsartan)
FA-202 Gimoti® (metoclopramide) Nasal Spray
FA-203 Amondys 45® (casimersen)
FA-204 Cabenuva® (cabotegravir and rilpivirine)
FA-205 Opzelura® (ruxolitinib)
Other Pharmacy Forms

Pharmacy forms are for completion and submission by current Medicaid providers only.

Form Number Title
FA-60 MAC Pricing Appeal Form
FA-62 Request for Pharmaceutical Product Review
Diabetic Supply Forms
Form Number Title
FA-200 Continuous Glucose Monitors (CGMs) Prior Authorization Request Form
FA-201 Insulin Pump Prior Authorization Request Form
Nevada DHCFP Form
Form Number Title
NMO-4 Request for Pharmacy Change for Lock-In Recipients