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
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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_BillingGuidelines_PT22-attachmentA.pdf
... 1 unit per 6 months D1351 DENTAL SEALANT PER TOOTH 00 NC NC 1 per 60 months, limited to FULLY erupted permanent pre- molars and 1st and 2nd ...
Terms matched: 1  -  Score: 309  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_BillingGuidelines_PT22-attachmentB.pdf
... of fluoride 00 1 unit per 6 months D1351 Sealant - per tooth 1 per 60 months, limited to FULLY erupted permanent 00 pre-molars and 1st and 2nd molars ...
Terms matched: 1  -  Score: 191  -  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 ... Resolved (If Applicable) 60 Claims, Some institutional ... Resolved (If Applicable) 120 Claims, Some claims ...
Terms matched: 3  -  Score: 436  -  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_Specialty_188_20231206.pdf
... Provider Type 17 Specialty 188 Billing Guide Special Clinics: Certified Community Behavioral Health Center (CCBHC) Program Overview Effective July 1, 2019, Special Clinics ( ...
Terms matched: 1  -  Score: 147  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
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