Nevada Medicaid and Nevada Check Up News (First 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

NOTIFICATION:The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, April 27, 2025, for scheduled maintenance:
  • Secure Provider Web Portal (PWP), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Contact Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Type 20:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for this provider type from May 5, 2025 – May 12, 2025. Please refer to Web Announcement 3595 for details.

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2025 Professional Claims. See Web Announcement 3616.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2024. See Web Announcement 3458.

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

Provider Flex - Nevada Medicaid's New Provider Enrollment Portal

All providers are required to submit their provider enrollment or re-enrollment applications electronically via the Provider Flex tool at https://www.medicaid.nv.gov/hcp42/provider/Home/tabid/477/Default.aspx. Paper applications are not accepted.


All enrollment documents require an electronic signature from the provider or owner.



Resources
Title Description
Enrollment Checklists Enrollment checklists contain provider type specific attachments or requirements for enrollment.
Provider Enrollment Information Booklet All providers will need the information contained in this booklet, which includes common enrollment questions and information about out-of-state providers and provider groups.
YouTube Playlist for Provider Flex, Enrollment Powered by Gainwell Instructional Videos This playlist houses all instructional videos related to the Provider Flex Enrollment tool. Provider Flex will be used for most enrollment related tasks. It is not the same as the Provider Web Portal (PWP).
Provider Flex Overview Takeaway Partner deliverable to the Provider Flex Overview training. Includes key features, linked resources, and important dates for the phased implementation of the new Provider Flex enrollment tool.
Urgent/Emergency Provider Enrollment Quick Reference Guide Enrollment information specific to urgent/emergency providers. Includes required miscellaneous attachments, important links, and more.
Provider Flex Frequently Asked Questions (FAQ) A list of the most frequently asked questions about the Provider Flex Enrollment Portal. This document will be updated periodically to reflect new questions.
Subscribe to Provider Flex Frequently Asked Questions Please enter your name and email address in this form to subscribe to our weekly frequently asked questions (FAQ) regarding Provider Flex. Starting in April 2025, this FAQ will be updated and sent out weekly based on questions submitted.
Training Opportunities

If you would like to register for training opportunities, click on the Provider Training Portal button below to access the Absorb Learning Management System (LMS) and enroll in one of the sessions. For information on registering, logging in, and navigating the Absorb LMS please click the Tip Sheet button below.



News and Updates