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Announcements
Latest News
Nevada Medicaid and Nevada Check Up News (Second 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]
Featured Links
Notifications
Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey
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 July 2024 Professional Claims. See Web Announcement 3398.
Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.
Top Prior Authorization Denial Reasons for the Second Quarter of 2024. See Web Announcement 3427.
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.
Provider Links
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 Enrollment
Thank you for your interest in the Nevada Medicaid and Nevada Check Up Program. This page contains all of the information and forms you will need to become a Nevada Medicaid provider. If you have any questions, please contact the Provider Enrollment Unit at (877) 638-3472 from 8 a.m. to 5 p.m. Pacific Time Monday through Friday.
All providers are required to submit their provider enrollment or re-enrollment applications electronically via the Online Provider Enrollment (OPE) tool at https://www.medicaid.nv.gov/hcp42/provider/Home/tabid/477/Default.aspx. Paper applications are not accepted.
All enrollment documents including attachments require an original signature from the provider or an authorized representative (use dark blue or black ink).
Required Enrollment Documents
- 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.
- Enrollment Checklists: Copies of certain documents must be included with your Provider Enrollment Packet (e.g., copy of professional certification, proof of insurance, background check). The Enrollment Checklists show required documentation for each provider type.
- Associated Providers List for Nevada Medicaid Provider Group Enrollment: This completed Associated Providers List must be consistent with the information listed on the application, and must be uploaded with the original submission in order for your application to be considered complete. Original signatures are required for each individual being linked to the group.
- Business Associate Addendum (NMH-3820): This document must be signed and submitted with your Provider Enrollment/Revalidation Packet if it is listed on the Provider Enrollment Checklist for your Provider Type and when requested by the Division of Health Care Financing and Policy (DHCFP) or Nevada Medicaid.
- Advance Directives Compliance Self-Evaluation & Certification (NMH-3827): This form must be completed and submitted to DHCFP if it is listed on the Provider Enrollment checklist for your Provider Type.
- Civil Rights Compliance Self-Evaluation & Certification (NMH-3828): This form must be completed and submitted to DHCFP if it is listed on the Provider Enrollment checklist for your Provider Type.
- Electronic Funds Transfer (EFT) Authorization Form
Online Provider Enrollment User Manual
- Chapter 1: Getting Started
- Chapter 2: Initial Enrollment Application
- Chapter 2 Addendum: Ownership & Relationships Example
- Chapter 3: Revalidation and Updates
Revalidation Report
- Provider Revalidation Report: The Nevada Medicaid Provider Revalidation Report lists each provider and the date their next revalidation is due. To avoid contract termination, your revalidation application must be processed and approved prior to the revalidation due date. Providers can start their revalidation process up to a year in advance. Revalidations submitted prior to one year in advance will be returned.
Provider Enrollment and Revalidation Instruction Materials
| Date | Topic |
|---|---|
| April 2023 | Information for Individuals Preparing to Enroll with Nevada Medicaid (Quick Reference Guide) |
| April 2023 | Information for Groups Preparing to Enroll with Nevada Medicaid (Quick Reference Guide) |
| January 2023 | Ordering, Prescribing and Referring Provider Enrollment Frequently Asked Questions (FAQs) |
| - | Provider Enrollment Training Courses – Register Here |
| - | Provider Enrollment Instructional Videos – View Here |
Hospital Presumptive Eligibility Documents
- Web Announcement 3306: Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines for 2024
- Web Announcement 1008: Attention ALL Hospital Presumptive Eligibility Providers: Guidance Policy Available
- Web Announcement 861 with Training Schedule: Implementation of Hospital Presumptive Eligibility Option for Acute Care Hospitals (Provider Types 11 and 75)
- Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum: Qualified hospitals must complete and submit the Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum.
- Hospital Presumptive Eligibility Training Sign-Up Sheet: Complete this form listing the hospital employees that will be attending the mandatory training for Presumptive Eligibility. You will be notified by the DWSS in regards to the training dates and times. Keep in mind that each employee making PE determinations MUST be trained by DWSS and complete a competency examination prior to making ANY determinations.
Pregnancy Presumptive Eligibility Documents
- Pregnancy Presumptive Eligibility Participation Guidelines and Billing Instructions: Pregnancy Presumptive Eligibility Participation Guidelines and Billing Instructions.
- Pregnancy Presumptive Eligibility Provider Addendum: Qualified providers must complete and submit the Nevada Medicaid Presumptive Eligibility Provider Addendum.
- Pregnancy Presumptive Eligibility Training Sign-Up Sheet: Complete this form listing the employees that will be attending the mandatory training for Pregnancy Presumptive Eligibility. You will be notified by the DWSS in regards to the training dates and times. Keep in mind that each employee making PE determinations MUST be trained by DWSS and complete a competency examination prior to making ANY determinations.
Changes to Provider Information
Changes to any information presented on your enrollment documents must be reported to Nevada Medicaid within five business days.
- To complete changes online, please login to the Secure Web Portal, and choose “Revalidate-Update Provider”.
- To report a change in business ownership, submit a completed Provider Enrollment Application.
Provider License Updates and Voluntary Terminations Only
- Please submit provider license updates via the secure Provider Web Portal or email to Nevada Medicaid at nv.providerapps@gainwelltechnologies.com for processing.
- Please email voluntary termination forms (FA-34) to Nevada Medicaid at nv.providerapps@gainwelltechnologies.com for processing.
Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes, descriptions and data are copyrighted by the American Medical Association (AMA) and the American Dental Association (ADA), respectively, all rights reserved. AMA and ADA assume no liability for data contained or not contained on this website and on documents posted herein.
CPT is a registered trademark ® of the AMA. CDT is a registered trademark ® of the ADA. Applicable FARS/DFARS apply.
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