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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Provider Flex is coming soon!
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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31. NV_BillingGuidelines_PT54_20190131.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 375  -  17 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20190131.pdf
32. NV_BillingGuidelines_PT54 o100111-online120511-n110215.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 375  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54%20o100111-online120511-n110215.pdf
33. NV_BillingGuidelines_PT54_20151102.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 375  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20151102.pdf
34. NV_BillingGuidelines_PT54_20160309.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. ( ... disenroll from the Managed Care Organization (MCO) . Recipients in areas where MCO ...
Terms matched: 2  -  Score: 375  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20160309.pdf
35. NV_BillingGuidelines_PT54__20100628.pdf
... A recipient diagnosed with SED or SMI chooses to disenroll from the TCM services do ... in areas where Managed Care Organization (MCO) enrollment is mandatory may disenroll from ...
Terms matched: 2  -  Score: 365  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54__20100628.pdf
36. NV_BillingGuidelines_PT54_20100513.pdf
... A recipient diagnosed with SED or SMI chooses to disenroll from the TCM services do ... in areas where Managed Care Organization (MCO) enrollment is mandatory, may disenroll ...
Terms matched: 2  -  Score: 365  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20100513.pdf
37. NV_BillingGuidelines_PT54_20111205.pdf
... A recipient diagnosed with SED or SMI chooses to disenroll from the MCO. ( ... in areas where Managed Care Organization (MCO) enrollment is mandatory may disenroll from ...
Terms matched: 2  -  Score: 363  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54_20111205.pdf
38. NV_BillingGuidelines_PT54.pdf
... A recipient determined as SED or SMI chooses to disenroll from the MCO. If ... disenroll from the Managed Care Organization (MCO) based on an SMI determination. ...
Terms matched: 2  -  Score: 363  -  17 Jun 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT54.pdf
39. web_announcement_272_20090708.pdf
... enrollment period during which period they may choose to change their health plan. Recipients ... Web Announcement 272 Managed Care Organization (MCO) Changes: 12-Month Recipient Lock-In Policy ...
Terms matched: 2  -  Score: 347  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_272_20090708.pdf
40. newsletter_v6i2.pdf
... the recipie nt’s health choose to change their health plan. care ... CONTENTS: Home Safety Message Page 2 MCO Lock-in Policy Page 3 Clinical Claim Editor ...
Terms matched: 2  -  Score: 346  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v6i2.pdf
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