Nevada Medicaid and Nevada Check Up News (Third Quarter 2019 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]


Urgent Notification:
Currently, some providers submitting Group Applications, Group Changes and Group Revalidations do not have the option in the Online Provider Enrollment system to select associated providers or change individual providers associated with the group. This is a known issue and a fix is being researched. In the meantime, providers can complete the Associate Provider list and submit it with the request. Individual applications are not impacted by this issue. The Associate Provider list is available at the following link:

Known Modernization System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2019 Claims. See Web Announcement 1979.

Paper claims are no longer accepted by Nevada Medicaid. Please refer to Web Announcement 1733 and Web Announcement 1829 for additional information.

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

Notice Date Title
Oct. 7, 2019 Respiratory Syncytial Virus (RSV) Prophylaxis with Synagis® (Palivizumab)
September 24, 2019 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (SUPPORT Act) Compliance
September 10, 2019 Urgent: Physician-Administered Drug (PAD) Claim Processing
September 4, 2019 Pharmacy Website Updated to Display Silver State Scripts Board
September 3, 2019 Drug Use Review (DUR) Board Approves Changes Effective September 2, 2019
July 25, 2019 Update to Compounded Medications Prior Authorization Requirement
July 12, 2019 Silver State Scripts Board Replaces Pharmacy and Therapeutics (P&T) Committee
June 12, 2019 Compounded Medications Require Prior Authorization Effective June 3, 2019
June 12, 2019 New and Updated Pharmacy Prior Authorization Forms
May 31, 2019 Drug Use Review (DUR) Board Approves Changes Effective June 3, 2019
May 6, 2019 Nevada Medicaid Human Papillomavirus (HPV) Vaccine Policy Effective May 6, 2019
March 15, 2019 Drug Use Review (DUR) Board Approves Changes Effective February 4, 2019
March 14, 2019 Nevada Medicaid Drug Use Review Board Votes to Adopt Policy on Outpatient Antibiotic Medications
Dec. 10, 2018 Medicare Part D Co-Pay Reimbursement Increase
Nov. 21, 2018 Nevada Medicaid Antibiotic Policy Newsletter
Nov. 8, 2018 DHCFP to Host Antibiotic Policy & Provider Education Webinar (Updated December 6, 2018)
Oct. 25, 2018 Respiratory Syncytial Virus (RSV) Prophylaxis with Synagis® (Palivizumab)
Sept. 10, 2018 Drug Use Review (DUR) Board Approves Changes Effective July 2, 2018
Aug. 6, 2018 Drug Use Review (DUR) Board Approves Changes Effective August 6, 2018
June 21, 2018 Pharmacy Announcement: Prior Authorization for High Dollar Claims will be Implemented August 6, 2018
June 20, 2018 Drug Use Review (DUR) Board Approves Changes Effective May 7, 2018
June 7, 2018 Hospira Issues Voluntary Nationwide Recall for Two Lots of Naloxone Hydrochloride Injection
May 7, 2018 Prior Authorization Required for Mavyret™ and Vosevi®
Feb. 2, 2018 Drug Use Review (DUR) Board Approves Change Effective February 5, 2018
Jan. 2, 2018 Medicare Part-D Co-Pay Change
Dec. 29, 2017 Drug Use Review (DUR) Board Approves Changes Effective January 1, 2018
Dec. 22, 2017 Coverage Requirements for Contraceptive Drugs, Devices and Services to Implement on January 1, 2018
Oct. 6, 2017 Respiratory Syncytial Virus (RSV) Prophylaxis with Synagis® (Palivizumab)
Oct. 6, 2017 Insulin Quantity Limit Adjusted to Allow 65 to 120 Day Supply
Oct. 2, 2017 Legislative Assembly Bill AB473 Extends NRS 422.4025 Sunset until June 30, 2019
July 31, 2017 Drug Use Review (DUR) Board Approves Changes Effective August 1, 2017
May 5, 2017 Criteria for Practitioners to Dispense Medications
May 2, 2017 Drug Use Review (DUR) Board Approves Changes to MSM Chapter 1200
May 1, 2017 Quantity Limits Approved at January 2017 Drug Use Review Board Meeting
March 30, 2017 Opioid Therapeutic Class to be Added to Medicaid Services Manual (MSM) Chapter 1200 (Prescribed Drugs) (Updated April 28, 2017)
Feb. 23, 2017 Attention Prescribers and Pharmacies: Mandatory Three-Month Supplies for Maintenance Medications
Feb. 10, 2017 Pharmacy Announcement: Bypass Function Added for Claims for Children under Age 18 with a Diagnosis Related to a Seizure Disorder when Prescriber is a Neurologist (Updated March 24, 2017)
Previous Years’ Announcements
Notice Date Title
2016 All 2016 Pharmacy Announcements
2015 All 2015 Pharmacy Announcements
2014 All 2014 Pharmacy Announcements
2013 All 2013 Pharmacy Announcements
2012 All 2012 Pharmacy Announcements
2011 All 2011 Pharmacy Announcements
2010 All 2010 Pharmacy Announcements
2009 All 2009 Pharmacy Announcements
2008 All 2008 Pharmacy Announcements
2007 All 2007 Pharmacy Announcements
2006 All 2006 Pharmacy Announcements
2005 All 2005 Pharmacy Announcements

Nevada Medicaid offers comprehensive provider training free of charge. We encourage the attendance of health care providers, direct practitioners, billing staff, billing agencies, office managers, admitting or front-desk staff, utilization review staff, case management staff, etc.

Form Number Title
FA-43 No Pharmacy provider training scheduled at this time