Nevada Medicaid and Nevada Check Up News (Third Quarter 2019 Provider Newsletter) [Read]

Behavioral Health Providers Invited to Attend Monthly DHCFP Webinars [See Web Announcement 1628]

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]


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

Nevada Medicaid Forms Can Now Be Submitted Using the Provider Web Portal

On July 6, 2015, Nevada Medicaid completed updating all of the Nevada Medicaid forms that are available on this website. These forms have been updated to a format that allows them to be completed, downloaded and saved electronically. In addition, an enhancement has been made to allow some forms to be submitted online using the “Upload Files” page on the Provider Web Portal.

Please see Web Announcement 938 for the list of forms that can be uploaded using the “Upload Files” page on the Provider Web Portal, the types of forms that may not be uploaded, and screenshots and instructions for uploading forms. Upload instructions are also available in the new Electronic Verification System (EVS) User Manual Chapter 8.

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 Xolair® (omalizumab)
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™
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
Nevada DHCFP Form
Form Number Title
NMO-4 Request for Pharmacy Change for Lock-In Recipients