Nevada Medicaid and Nevada Check Up News (Second Quarter 2026 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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IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for September 2026 Professional Claims. See Web Announcement 4031.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 4053.

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 https://NevadaMedicaid.nv.gov/ and the Billing Guide for your provider type at www.medicaid.nv.gov.

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1. Nursing_Facility_Tracking_Form_Validation_Guide_2016-0615.pdf
... the NF admit date. Review the LOC start date in applicant lookup. June 15, 2016 Page 1 of 1 ...
Terms matched: 1  -  Score: 20  -  05 Nov 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Nursing_Facility_Tracking_Form_Validation_Guide_2016-0615.pdf
2. PASRR_LOC_NF_Training_2021.pdf
... Level II determinations. Nevada Medicaid â€" PASRR / LOC / NF Training 15 What is the PASRR Screening Tool? What is the PASRR Screening Tool? ...
Terms matched: 1  -  Score: 14  -  27 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PASRR_LOC_NF_Training_2021.pdf
3. EVS_FAQ.pdf
... match the NPI and provider name as indicated in the email) Updated 04/15/2025 Page 1 of 5 pv04/11/2022 Nevada Medicaid and ...
Terms matched: 1  -  Score: 97  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS_FAQ.pdf
4. PT29_PA_FAQ.pdf
... may be approved for up to 60 days. The request must be submitted within 15 business days of the initial evaluation and start of care. b. If ...
Terms matched: 1  -  Score: 56  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT29_PA_FAQ.pdf
5. NV_Billing_General.pdf
... : Peer-to-Peer Review or Reconsideration for Throughout additional information document Updates made throughout 12/15/2025 Updated title of Medicaid Services Manual Chapter 1300 to Durable 9 Medical ...
Terms matched: 1  -  Score: 105  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
6. NV_Billing_General_20261008.pdf
... : Peer-to-Peer Review or Reconsideration for Throughout additional information document Updates made throughout 12/15/2025 Updated title of Medicaid Services Manual Chapter 1300 to Durable 9 Medical ...
Terms matched: 1  -  Score: 72  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
7. OPR_FAQs.pdf
... CFR 455.440) . Effective with claims received by Nevada Medicaid on or after October 15, 2014, the NPI of the OPR provider must be included on Nevada ...
Terms matched: 1  -  Score: 59  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/OPR_FAQs.pdf
8. NV_EVS_User_Manual_Ch4.pdf
... PWP User Manual, Chapter 4 Updated 10/20/2025 (pv12/15/2025) Table of Contents 4.1. Acronyms .... 1 4.2. ...
Terms matched: 1  -  Score: 44  -  20 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
9. Provider_Enrollment_Information_Booklet.pdf
... 2: Application Types .... 14 Advance Directives and Civil Rights Compliance .... 15 Provider Groups Allowing Linkage .... 16 Table 3: Group Provider Enrollment Allowable ...
Terms matched: 1  -  Score: 124  -  19 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
10. FA-11E.pdf
... 97153 physician or other qualified health care professional, face-to-face with one patient, each 15 minutes Adaptive behavior treatment with protocol modification, administered by physician or other 97155 ...
Terms matched: 1  -  Score: 127  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
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