Nevada Medicaid and Nevada Check Up News (Third Quarter 2024 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, November 24, 2024, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR

Unwinding COVID-19 Information

Known 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 September 2024 Professional Claims. See Web Announcement 3465.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

Top Prior Authorization Denial Reasons for the Third Quarter of 2024. See Web Announcement 3488.

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
Important Dates
Date Title Details
TBD Coming Soon Please return periodically for updates to our important dates list.
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 Videos button below.

Key Features
Streamlined Disclosures, click for detail
Disclosures, Streamlined Process, Compliance Adherence, Clearer Direction, Time Savings
Attachment Process, click for details
Attachment Process, On Demand, Compliance Adherence, Improved Efficiency, Time Savings
Doc-u-sign, click for details
Doc-u-sign, Convenient Use, Enhanced Security, Integrated Into Tool, Time Savings
Reaccessing Data, click for details
Reaccessing Data, Auto Save, Enhanced Security, Password Resets, Time Savings
Integrated Checklists, click for details
Integrated Checklists, Convenient Use, Compliance Adherence, Improved Efficiency, Time Savings
Dashboard, click for details
Dashboard, Applications List, Intuitive Navigation, Enrollment Resources, Import Applications
Cover Card Content
News and Updates
Resources
Title Description
Coming Soon Please return periodically for updates to our resources list, which will include an FAQ, self-paced training videos, and quick reference guides, to name a few.