Nevada Medicaid and Nevada Check Up News (First 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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for April 2026 Professional Claims. See Web Announcement 3915.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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. Pregnancy_Presumptive_Eligibility_Addendum.pdf
... that either party may terminate this Addendum without cause at any time with thirty (30) days prior written notice to the other party. The parties agree that ...
Terms matched: 1  -  Score: 20  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Addendum.pdf
2. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
3. Known_Issues.pdf
... Resolution/Work Around Date Date Recycle Date # Reported Resolved (If Applicable) 30 Claims, Non- Claims are denying inappropriately for Procedure • Provider ...
Terms matched: 1  -  Score: 217  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
4. Error_Code_to_EOB_to_ANSI.pdf
... MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are ... acceptable maximum. 5749 4 MODALITIES AND/OR THER ... PER 5749 4 modalities and/or therapeutic procedures 119 ...
Terms matched: 3  -  Score: 150  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
5. NV_BillingGuidelines_PT11_online_082725.pdf
... eligibility during their stay. If a recipient has been in the hospital for over 30 days when retroactive eligibility is determined, providers must: o Submit clinical information ...
Terms matched: 1  -  Score: 62  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
6. NV_BillingGuidelines_PT11.pdf
... eligibility during their stay. If a recipient has been in the hospital for over 30 days when retroactive eligibility is determined, providers must: o Submit clinical information ...
Terms matched: 1  -  Score: 62  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
7. NV_BillingGuidelines_PT60.pdf
... treatment, the treatment framework, the modality of treatment, the frequency and estimated ... ., each 15 minutes or each 30 minutes, each of these timed segments ...
Terms matched: 2  -  Score: 431  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
8. NV_BillingGuidelines_PT60_2025-1216.pdf
... treatment, the treatment framework, the modality of treatment, the frequency and estimated ... ., each 15 minutes or each 30 minutes, each of these timed segments ...
Terms matched: 2  -  Score: 431  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
9. web_announcement_3891_20260410.pdf
... That Denied Will Be Reprocessed Attention Provider Types 29 (Home Health Agency), 30 (Personal Care Services - Provider Agency), 83 (Personal Care Services ...
Terms matched: 1  -  Score: 23  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3891_20260410.pdf
10. web_announcement_3897_20260421.pdf
... 85) Tuesday May 5, 2026 1:00 p.m. to 2:30 p.m. Submitting Secondary Claims - Thursday May 7, 2026 10:00 ...
Terms matched: 1  -  Score: 97  -  22 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3897_20260421.pdf
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