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. Known_Issues.pdf
... Resolution/Work Around Date Date Recycle Date # Reported Resolved (If Applicable) 60 Claims, Some institutional claims are being denied • Provider: No ...
Terms matched: 1  -  Score: 50  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EVS_User_Manual_Ch3.pdf
... example (Professional claim): 59 Detail level example (Professional claim): 60 Institutional claims • The total payment by other insurers must be entered ...
Terms matched: 1  -  Score: 12  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
3. NV_BillingGuidelines_PT14.pdf
... LMFT, LCPC of the session. Authorization Requirements above is required to exceed the 60 minutes; bill one service unit per day limitations See Outpatient 90839 Psychotherapy for ...
Terms matched: 1  -  Score: 42  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
4. NV_BillingGuidelines_PT14_online_011226.pdf
... of the session. the Intensity of LMFT, LCPC Needs grid. 90837 Psychotherapy 60 minutes; bill one QMHP, The patient must be present for all or ...
Terms matched: 1  -  Score: 42  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
5. Error_Code_to_EOB_to_ANSI.pdf
... . 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... may be comprised of auto-recycle weekly for 60 days. After 60 either the NCPDP ...
Terms matched: 2  -  Score: 454  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... Based Services Waiver for the Elderly â€" Augmented Personal Care Services School Based 60 Specialty type code: • 960: School Based Residential Treatment Center ...
Terms matched: 1  -  Score: 36  -  09 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_BillingGuidelines_PT22-attachmentB_01-29-26.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  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
8. 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  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
9. 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
10. NV_EVS_User_Manual_Ch10.pdf
... Revalidation Letter - 30 Days Final Notice • PRV-9060-R Provider Revalidation Notice - 60 Days First Notice • PRV-9062-R Revalidation Approval Letter • PRV-9064-R ...
Terms matched: 1  -  Score: 20  -  21 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch10.pdf
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