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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EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
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Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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. 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  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. web_announcement_Volume 22 Issue 3_20250930.pdf
... QRR) surveys may assist in justifying rate adjustments. Data gathered from provider responses di- rectly contributes to the analysis of current reimbursement rates and may assist in ...
Terms matched: 1  -  Score: 13  -  30 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2022%20Issue%203_20250930.pdf
3. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
4. Incretin_Mimetics_2013-0812.pdf
... Incretin Mimetics 2013 0812 ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Incretin_Mimetics_2013-0812.pdf
5. Incretin Mimetics_09222016.pdf
... 10.2337/dc13-2760. 13. Home PD, Shamanna P, Stewart M, Yang F, Miller M, Perry C, et al. Efficacy and tolerability ...
Terms matched: 1  -  Score: 12  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Incretin%20Mimetics_09222016.pdf
6. Immunomodulators_2018-0910.pdf
... 2462-76. ï ‚ Ryoo JY, Yang HJ, Ji E, Yoo BK ... 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-0910.pdf
7. Immunomodulators_2018-09.pdf
... 2462-76. ï ‚ Ryoo JY, Yang HJ, Ji E, Yoo BK ... 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-09.pdf
8. Immunomodulators_2017-1228.pdf
... 2462-76. ï ‚ Ryoo JY, Yang HJ, Ji E, Yoo BK ... 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-1228.pdf
9. Immunomodulators_2017-0615.pdf
... :2462-76. x Ryoo JY, Yang HJ, Ji E, Yoo BK ... 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-0615.pdf
10. Immunomodulators_2017-09.pdf
... 2462-76. ï ‚ Ryoo JY, Yang HJ, Ji E, Yoo BK ... 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-09.pdf
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