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: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time on Sunday, March 22, 2026, for scheduled maintenance:
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    • Gainwell Technologies Contact Center (877) 638-3472
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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

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 https://NevadaMedicaid.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  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Provider_Enrollment_Information_Booklet.pdf
... ¢ 930: Personal Care Services - Provider Agency (EVV Required) Ambulance, Air or Ground Specialty type code: 32 • 249: Community Paramedicine ...
Terms matched: 1  -  Score: 34  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. Known_Issues.pdf
... Applicable) 64 Claims, Provider Some claims for Provider Type 32-(Ambulance Air • Provider: No additional action needed. 1/14/ ...
Terms matched: 1  -  Score: 49  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
4. Team_Territories.pdf
... ¢ 21 â€" Podiatrist • 32 â€" Ambulance, Air or Ground • 34 â€" Therapy • 35 ...
Terms matched: 1  -  Score: 21  -  06 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Team_Territories.pdf
5. NV_BillingGuidelines_PT34_2023-1121.pdf
... 94010, with administered agents (e.g., antigen[s ], cold air, methacholine) Updated 11/21/2023 Provider Type 34 Billing Guide ...
Terms matched: 1  -  Score: 12  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
6. NV_BillingGuidelines_PT34.pdf
... 94010, with administered agents (e.g., antigen[s ], cold air, methacholine) Updated 01/01/2026 Provider Type 34 Billing Guide ...
Terms matched: 1  -  Score: 12  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
7. NV_BillingGuidelines_PT60_2024-0828.pdf
... • Limit 1 unit per day 92551 Screening test, pure tone, air only. • Encounter = 1 unit Includes testing of both ears ...
Terms matched: 1  -  Score: 12  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
8. NV_BillingGuidelines_PT60.pdf
... • Limit 1 unit per day 92551 Screening test, pure tone, air only. • Encounter = 1 unit Includes testing of both ears ...
Terms matched: 1  -  Score: 12  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
9. NV_BillingGuidelines_PT33_20250623.pdf
... corner chairs Household items, such as but not limited to: • Air conditioners (includes swamp coolers) • Appliances (microwave, cutting ...
Terms matched: 1  -  Score: 24  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
10. NV_BillingGuidelines_PT33.pdf
... corner chairs Household items, such as but not limited to: • Air conditioners (includes swamp coolers) • Appliances (microwave, cutting ...
Terms matched: 1  -  Score: 24  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
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