Medical billing services in Nevada

Billing in Nevada: what's different

The rules below change how a claim is filed and paid in Nevada. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.

Rules that change how Nevada claims are billed

• Statewide managed care since January 1, 2026, with a fixed list of who stays out⁵

  MSM Chapter 3600 records that the mandatory managed care program covered only urban Clark and Washoe counties until statewide managed care took effect on January 1, 2026, and that Nevada Medicaid contracts with five HMOs as MCOs and one prepaid ambulatory health plan as the dental benefits administrator. Enrollment is mandatory for the Family Medical Coverage, Nevada Check Up and aged-out foster care medical-only groups. Excluded from managed care: recipients served through child welfare or foster care, ICF/IID residents, nursing facility stays over 180 calendar days, swing bed stays over 45 calendar days, hospice recipients, 1915(c) waiver enrollees and the aged, blind and disabled category. American Indian and Alaska Native members, children and youth with special health care needs and severely emotionally disturbed members may enroll voluntarily. A biller reads the eligibility response for the plan name before deciding where the claim goes.

• What the 2026 expansion moved, in Nevada Medicaid's own numbers⁶

  The statewide managed care page puts the pre-2026 program at about 75 percent of the Medicaid population in two urban counties, moves about 75,000 rural children, parents and adults without children into health plans from January 1, 2026, and keeps about 126,000 people in fee-for-service: children in foster care, juvenile justice and child welfare, people with disabilities, seniors 65 and older and recipients of the three home and community-based waiver programs. The plans were procured under RFP 40DHHS-S3037. For a rural practice this is the first year that most of its Medicaid patients carry a plan ID card, and the first year it needs contracts with up to five plans instead of one fiscal agent.

• Credentialing is centralized, and enrollment and credentialing are separate steps³

  Since the February 28, 2025 go-live, Nevada Medicaid runs centralized credentialing through Verisys as its credentialing verification organization, while Gainwell Technologies, the fiscal agent, handles enrollment. Credentialing decides whether a provider is qualified on education, licensure and work history; enrollment decides whether the applicant meets fee-for-service screening requirements. Every applicant must hold an active Nevada Medicaid contract or an application under review before credentialing starts, and individual providers register in the CAQH database with Nevada selected. The page lists five managed care entities and one dental plan with the numbers to call to join each network, which is the practical order of work: enroll, credential once, then contract plan by plan.

• Revalidation can be filed up to 365 days early, and everything goes through the portal⁴

  MSM Chapter 100 lets an active provider submit a complete revalidation application up to 365 days before the revalidation due date, and requires every enrollment, re-enrollment and revalidation application, with its supporting documents, to be filed online through the Provider Portal. Prior authorization requests go through the same portal, and waiting until the claim is due to request one does not override the stale date. Address changes and other changes to provider information are due in writing within 30 calendar days, a terminated provider has 90 days to request a fair hearing, and a provider who terminates voluntarily cannot re-enroll for 365 days unless an access-to-care issue exists.

• SilverSummit publishes its clean claim payment levels and a 180-day window¹¹

  The 2026 SilverSummit Healthplan provider billing manual states that clean claims are adjudicated, paid or denied, at 90 percent within 30 calendar days and 99 percent within 90 calendar days of receipt, defines a clean claim as one in a nationally accepted format that needs no further information, adjustment or alteration to be processed, and sets timely filing at 180 calendar days from the date of service or date of eligibility for claims, encounters and corrected claims, or 365 calendar days when SilverSummit is the secondary payer. Claims missing required data are returned rather than accepted, so they never start the clock; a biller treats a returned claim as unfiled.

• NEMT follows MSM Chapter 1900, with the rural counties now on the health plans¹⁴

  Effective January 1, 2026, Chapter 1900 divides Nevada into urban areas, Clark and Washoe counties, and rural areas, the other 15 counties, and assigns the health plans responsibility for NEMT for their rural Medicaid and Nevada Check Up members. The transportation broker serves statewide and out of state, every NEMT service including out-of-state and long distance trips requires prior authorization by the broker except services from Indian Health Programs, and the broker must authorize the least expensive mode that fits the recipient's condition. When a request is denied or limited the broker sends a notice of decision within five business days with fair hearing rights. Transportation providers bill against those authorizations, not against a bare trip log.

Services for Nevada practices

Remitwright serves Nevada practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.

• Medical billingClaims worked by one named biller
• CredentialingEnrollment, CAQH and PECOS kept current
• Eligibility verificationCoverage and benefits checked before visits
• Prior authorizationAuths requested, tracked, attached to claims
• Denial managementEvery denial read, worked and appealed
• A/R follow-upUnpaid claims chased before filing limits