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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

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1. Error_Code_to_EOB_to_ANSI.pdf
... length, post the edit at the header. 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 24  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_Billing_General_20251215.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
3. NV_Billing_General.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. NV_Billing_General_20251017.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
5. NV_BillingGuidelines_PT33_20250623.pdf
... submitted in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards. • For HCPCS code descriptions that identify multiple components, ...
Terms matched: 1  -  Score: 13  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
6. NV_BillingGuidelines_PT33.pdf
... submitted in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards. • For HCPCS code descriptions that identify multiple components, ...
Terms matched: 1  -  Score: 13  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
7. web_announcement_3753_20251024.pdf
... employment solutions: Not âœ" âœ" available 844-396-2329 GED, HISet tests, industry certification, money for work clothes; $100 gym ChooseAnthem.com/nv membership ...
Terms matched: 1  -  Score: 14  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
8. Benefit_Enrollment_and_Maintenance_(834).pdf
... of Council for Affordable Quality Healthcare, CORE is a committee of more than 100 industry leaders who help create and promulgate a set of voluntary business rules focused on ...
Terms matched: 1  -  Score: 31  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
9. NV_Billing_General_20250801.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
10. NV_Billing_General_20250220.pdf
... the request Nevada Medicaid uses standard, industry guidelines to determine if the requested service ... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ...
Terms matched: 2  -  Score: 42  -  29 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250220.pdf
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