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. NV_BillingGuidelines_PT22-attachmentA.pdf
... service unit per 12 rolling months D0150 COMPREHENSVE ORAL EVALUATION 00 1 service unit per 36 rolling months (for 21 years and older with dentures) D0160 EXTENSV ORAL ...
Terms matched: 1  -  Score: 337  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_BillingGuidelines_PT22-attachmentB.pdf
... on the same date of service. 1 service unit (complete series) per 36 rolling months. D0220 Intraoral - Periapical first radiographic image 1 service unit per ...
Terms matched: 1  -  Score: 263  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
3. Known_Issues.pdf
... , Claims submitted by provider types 24-(Advanced ... on the Web Portal. 36 Claims, PCS Some ... ) (Substance Abuse Agency Model (SAAM)) ...
Terms matched: 3  -  Score: 435  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
4. NV_EnrollmentChecklist_PT93_Spec707_Flex.pdf
... Provider Enrollment Checklist Provider Type 93: Substance Use Treatment Specialty 707: Substance Use Treatment Clinic Please refer to the Provider Enrollment Information Booklet for guidance and to ...
Terms matched: 1  -  Score: 74  -  26 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec707_Flex.pdf
5. NV_EnrollmentChecklist_PT93_Spec707.pdf
... Provider Enrollment Checklist Provider Type 93: Substance Use Treatment Specialty 707: Substance Use Treatment Clinic Please refer to the Provider Enrollment Information Booklet for guidance and to ...
Terms matched: 1  -  Score: 74  -  26 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec707.pdf
6. NV_EnrollmentChecklist_PT17_Spec188_Flex.pdf
... Provider Enrollment Checklist Provider Type 17: Special Clinics Specialty 188: Certified Community Behavioral Health Center (CCBHC) Please refer to the Provider Enrollment Information Booklet for ...
Terms matched: 1  -  Score: 76  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT17_Spec188_Flex.pdf
7. NV_EnrollmentChecklist_PT17-188.pdf
... Provider Enrollment Checklist for Provider Type 17 Special Clinics - Specialty 188, Certified Community Behavioral Health Center (CCBHC) The following is a list of required enrollment ...
Terms matched: 1  -  Score: 68  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT17-188.pdf
8. NV_EnrollmentChecklist_PT93_Spec704.pdf
... Provider Enrollment Checklist for Provider Type 93 Specialty 704 Substance Use Treatment: Group Specialty 704, Residential Substance Use Treatment in an Institution for Mental Disease (IMD ...
Terms matched: 1  -  Score: 128  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
9. NV_EnrollmentChecklist_PT93_Spec704_Flex.pdf
... Provider Enrollment Checklist Provider Type 93: Substance Use Treatment Specialty 704: Residential Substance Use Treatment in an Institution for Mental Disease (IMD) Please refer to ...
Terms matched: 1  -  Score: 75  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704_Flex.pdf
10. NV_BillingGuidelines_PT17_Spec188.pdf
... Provider Type 17 Specialty 188 Billing Guide Special Clinics: Certified Community Behavioral Health ... is an extension of the CCBHC delivery model. DCOs may not bill Medicaid independently ...
Terms matched: 2  -  Score: 148  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
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