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]

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

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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.

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91. Nonsteriodal_Anti-Ulcer Agents_2015-0403.pdf
... . In either case, co-prescribe with a proton pump inhibitor (PPI), choosing the one with the lowest acquisition cost. • All oral NSAIDs ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nonsteriodal_Anti-Ulcer%20Agents_2015-0403.pdf
92. newsletter_v4i4.pdf
... 2 Diabetes Awareness Page 3 Billing Tips/Reminders Page 2 PERM Update Page 3 MCO Work Group Page 4 Nevada Medicaid News Updates on Major Issues NPI/API ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v4i4.pdf
93. Topical Immunomodulators_2015-1002.pdf
... alone. of disease flares and  A variety of factors should be considered when choosing a particular use of adjunctive topical corticosteroid for the treatment of AD, including ...
Terms matched: 1  -  Score: 11  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Topical%20Immunomodulators_2015-1002.pdf
94. NV_BillingGuidelines_PT43_20110606.pdf
... in a Managed Care and/or respiratory therapists’ drawing of Organization (MCO), it is the laboratory’s arterial blood. responsibility to ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20110606.pdf
95. NV_BillingGuidelines_PT12_online_20120710.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request PA from and submit claims to the MCO. For recipients ...
Terms matched: 1  -  Score: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20120710.pdf
96. NV_Medicaid_News_2016-0414.pdf
... has Medicaid coverage through one of the managed care organizations, then contact the appropriate MCO for prior au- thorization and billing instructions: Amerigroup Community Care (800 ...
Terms matched: 1  -  Score: 12  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2016-0414.pdf
97. web_announcement_39_111004.pdf
... June 15, 2005, and offers 4 (four) options for providers to choose in order to meet this requirement. All providers with a negative balance will ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_39_111004.pdf
98. newsletter_v3i1.pdf
... June 14, 2006 â€" Medicaid Health Services’ promotion of Electronic choose to attend only those classes that for Managers, Medicaid for Admitting & Data ...
Terms matched: 1  -  Score: 12  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v3i1.pdf
99. NV_BillingGuidelines_PT29_20101118.pdf
... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 35  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_20101118.pdf
100. NV_BillingGuidelines_PT38_20100630.pdf
... White Pine, Lander, Eureka, Humboldt, Pershing and Churchill. Recipients who choose self-directed services will be assisted by a Financial Management Service staff and a Support ...
Terms matched: 1  -  Score: 20  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT38_20100630.pdf
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