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.
Email: nvmmis.edisupport
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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. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... 6 rolling months D0150 Comprehensive oral examination - New Patient 00 1 service unit per 12 rolling months D0210 Intraoral - Complete series of radiographic images D0210 may not be ...
Terms matched: 1  -  Score: 191  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
2. NV_BillingGuidelines_PT22-attachmentB.pdf
... 6 rolling months D0150 Comprehensive oral examination - New Patient 00 1 service unit per 12 rolling months D0190 Screening of a patient 00 2 service units per 6 months ...
Terms matched: 1  -  Score: 191  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
3. NV_BillingGuidelines_PT22-attachmentA.pdf
... age of 3 years D0150 COMPREHENSVE ORAL EVALUATION 00 00 NC 1 service unit per 12 rolling months D0150 COMPREHENSVE ORAL EVALUATION 00 1 service unit per 36 rolling months ...
Terms matched: 1  -  Score: 326  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
4. Known_Issues.pdf
... ) units • Provider: No additional action 10/03/2025 12/15/2025 TBD Authorization equivalent to the allowed quantity submitted on the ...
Terms matched: 1  -  Score: 386  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
5. NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... lines, and must indicate the Q2 modifier on each of those lines. Updated 12/06/2023 Provider Type 17 Specialty 188 Billing Guide pv01/18 ...
Terms matched: 1  -  Score: 36  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
6. NV_EnrollmentCriteria_PT17_Spec188.pdf
... . 10. Complete a Needs Assessment. 11. Identify a Catchment Area. 12. Review the CASAT Technical Assistance Guide. 13. Satisfy documentation requirements for ...
Terms matched: 1  -  Score: 21  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
7. Provider_Enrollment_Information_Booklet.pdf
... Specialty type code: • 911: Hospital, Inpatient Hospital, Outpatient 12 Specialty type code: • 912: Hospital, Outpatient Psychiatric Hospital ...
Terms matched: 1  -  Score: 94  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
8. NV_EVS_User_Manual_Ch10.pdf
... . 3. Click the Report ID hyperlink to download and view the letter. 12 10.2.6 1099 IRS Tax Documents To search for available 1099 IRS Tax Documents, ...
Terms matched: 1  -  Score: 20  -  21 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch10.pdf
9. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... requests as soon as the recipient is placed on a wait list and include PT 12 or PT 20 as the rendering provider and the transplant CPT code. Dates ...
Terms matched: 1  -  Score: 61  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
10. NV_BillingGuidelines_PT14_online_030525.pdf
... 03/05/2025 Provider Type 14 Billing Guide pv11/19/2024 12 / 22 Provider Type 14 Billing Guide Behavioral Health Outpatient Treatment Billing Brief Description ...
Terms matched: 1  -  Score: 34  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
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