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 3978.

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. NV_Billing_General.pdf
... the MCO indicating the change. After submitting the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service/product meets payment requirements. Updated ...
Terms matched: 1  -  Score: 21  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
2. NV_Billing_General_20261008.pdf
... the MCO indicating the change. After submitting the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service/product meets payment requirements. Updated ...
Terms matched: 1  -  Score: 21  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
3. NV_Billing_General_20260710.pdf
... the MCO indicating the change. After submitting the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service/product meets payment requirements. Incomplete ...
Terms matched: 1  -  Score: 21  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
4. 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  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
5. NV_Billing_Sterilization.pdf
... the reimbursement for these NDCs will be automatically updated weekly keeping reimbursement in line with industry standards. Family planning: sterilization Medicaid payment is available for surgical procedures and ...
Terms matched: 1  -  Score: 12  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Sterilization.pdf
6. NCPDP_Encounter_Companion_Guide.pdf
... of Council for Affordable Quality Healthcare, CORE is a committee of more than 100 industry leaders who help create and promulgate a set of voluntary business rules focused on ...
Terms matched: 1  -  Score: 21  -  15 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NCPDP_Encounter_Companion_Guide.pdf
7. NV_BillingGuidelines_PT33.pdf
... submitted in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards. • For HCPCS code descriptions that identify multiple components, ...
Terms matched: 1  -  Score: 13  -  14 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
8. NV_BillingGuidelines_PT33_20260730.pdf
... submitted in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards. • For HCPCS code descriptions that identify multiple components, ...
Terms matched: 1  -  Score: 13  -  14 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20260730.pdf
9. Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
... of Council for Affordable Quality Healthcare, CORE is a committee of more than 100 industry leaders who help create and promulgate a set of voluntary business rules focused on ...
Terms matched: 1  -  Score: 62  -  04 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
10. Encounter-Professional_837P_MCO_Companion_Guide_-_Mod.pdf
... of Council for Affordable Quality Healthcare, CORE is a committee of more than 100 industry leaders who help create and promulgate a set of voluntary business rules focused on ...
Terms matched: 1  -  Score: 49  -  04 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Professional_837P_MCO_Companion_Guide_-_Mod.pdf
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