Nevada Medicaid and Nevada Check Up News (Fourth 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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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1. Provider_Enrollment_Information_Booklet.pdf
... • 307: Clinical Professional Counselor • 308: Day Treatment Model 14 • 814: Behavioral Health Outpatient Treatment Group • ...
Terms matched: 1  -  Score: 14  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
2. FA-1D.pdf
... 33 fee schedule, and an unaltered complete order form specific to the manufacturer and model of the items being requested must be attached. DME providers are required to ...
Terms matched: 1  -  Score: 41  -  23 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-1D.pdf
3. NV_Billing_General_20260101.pdf
... Evaluation • New requests for PDN Services Behavioral Health and Substance Abuse Agency Model (SAAM) Authorization Requests Provider Types 14, 82 and 17 (specialty ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
4. NV_Billing_General.pdf
... Evaluation • New requests for PDN Services Behavioral Health and Substance Abuse Agency Model (SAAM) Authorization Requests Provider Types 14, 82 and 17 (specialty ...
Terms matched: 1  -  Score: 11  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
5. Error_Code_to_EOB_to_ANSI.pdf
... Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 28  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. Known_Issues.pdf
... • Once resolved, claims will be Clinics) (Substance Abuse Agency Model (SAAM)) for automatically reprocessed. procedure code H0038-(Self-Help ...
Terms matched: 1  -  Score: 11  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
7. NV_BillingGuidelines_PT14_online_011226.pdf
... type 14 BHCN groups Day Treatment Attachment A, for with an approved Day Treatment Model services. complete guidelines. and additional enrollment as Specialty 308 can request prior ...
Terms matched: 1  -  Score: 11  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
8. NV_BillingGuidelines_PT14.pdf
... provider type 14 BHCN groups Day Treatment complete guidelines. with an approved Day Treatment Model services. and additional enrollment as Specialty 308 can request prior authorization for Day ...
Terms matched: 1  -  Score: 11  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
9. NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... a Designated Collaborating Organization (DCO) that is an extension of the CCBHC delivery model. DCOs may not bill Medicaid independently for services. All CCBHC and contracted ...
Terms matched: 1  -  Score: 44  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
10. NV_BillingGuidelines_PT17_Spec188.pdf
... a Designated Collaborating Organization (DCO) that is an extension of the CCBHC delivery model. DCOs may not bill Medicaid independently for services. All CCBHC and contracted ...
Terms matched: 1  -  Score: 44  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
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