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
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

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_EnrollmentChecklist_PT93_Spec704.pdf
... National Provider Identifier (NPI): ____ Please check one of the following boxes. Updates to Clinical Supervisors of the agency are reported using this form and ...
Terms matched: 1  -  Score: 41  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
2. Provider_Enrollment_Information_Booklet.pdf
... current This is the location where services are rendered and cannot be a post office box, gated community, or virtual address . Each service address for an organization ...
Terms matched: 1  -  Score: 10  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. 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
4. NV_Billing_General_20251017.pdf
... authorizations Phone: (800) 525-2395 Mail: Nevada Medicaid Dental PA P.O. Box 30042 Reno NV 89520-3042 Personal Care Services (PCS) authorizations Phone: ( ...
Terms matched: 1  -  Score: 51  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
5. NV_Billing_General_20251215.pdf
... authorizations Phone: (800) 525-2395 Mail: Nevada Medicaid Dental PA P.O. Box 30042 Reno NV 89520-3042 Personal Care Services (PCS) authorizations Phone: ( ...
Terms matched: 1  -  Score: 51  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
6. NV_Billing_General.pdf
... authorizations Phone: (800) 525-2395 Mail: Nevada Medicaid Dental PA P.O. Box 30042 Reno NV 89520-3042 Personal Care Services (PCS) authorizations Phone: ( ...
Terms matched: 1  -  Score: 51  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_EVS_User_Manual_Ch4.pdf
... a referring provider, complete one of the following options: 1. Check the box to indicate - Referring Provider same as Requesting Provider OR 2. Use the ...
Terms matched: 1  -  Score: 69  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
8. FA-11E-I.pdf
... EVS. Request Type: • Initial Prior Authorization: o Check this box if the recipient has not been previously treated by the agency. o For ...
Terms matched: 1  -  Score: 92  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E-I.pdf
9. web_announcement_3753_20251024.pdf
... comes to you in the mail to NV Medicaid, MCO Changes, P.O. Box 30042, Reno, NV 89520. Please include all household members’ ...
Terms matched: 1  -  Score: 12  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
10. NV_Flex_User_Guide_Individual.pdf
... selected. 9. Select “Click to Add a Specialty.â€A pop-up box will display the available specialties based on the provider type selected. Updated: ...
Terms matched: 1  -  Score: 41  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
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