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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

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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During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

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1. Known_Issues.pdf
... rule) and 4871-(Claim type restriction on proc billing table) . 100 Claims, Some Provider Type 22-(Dentist) are being †...
Terms matched: 1  -  Score: 11  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EVS_User_Manual_Ch3.pdf
... to the original 30 calendar days. Per Medicaid Services Manual (MSM) Chapter 100, Section 105.2C titled Disputed Payment, appeal requests for subsequent same service claim ...
Terms matched: 1  -  Score: 12  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
3. NV_BillingGuidelines_PT14_online_011226.pdf
... MSM Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed ...
Terms matched: 1  -  Score: 14  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
4. NV_BillingGuidelines_PT14.pdf
... MSM Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed ...
Terms matched: 1  -  Score: 14  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
5. Error_Code_to_EOB_to_ANSI.pdf
... . 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... the billed amount is less than $100. 5) Enforce PA edits for ...
Terms matched: 2  -  Score: 83  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... also published on the following website at https://dhcfp.nv.gov. MSM Chapter 100 contains specific enrollment requirements. General Information Enrollment requirements vary depending on provider type ...
Terms matched: 1  -  Score: 85  -  09 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_EnrollmentChecklist_PT93_Spec704.pdf
... _____ Policy Declaration I hereby declare that I have read the current MSM Chapters 100, 400, 3300 and 4100 as of the date above and understand this ...
Terms matched: 1  -  Score: 84  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
8. NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... MSM Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains important information applicable to all provider types. Authorization Requirements All services must ...
Terms matched: 1  -  Score: 38  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
9. NV_BillingGuidelines_PT17_Spec188.pdf
... MSM Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains important information applicable to all provider types. Authorization Requirements All services must ...
Terms matched: 1  -  Score: 38  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
10. NV_BillingGuidelines_PT14_online_030525.pdf
... MSM Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed ...
Terms matched: 1  -  Score: 16  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
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