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]

Notifications

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 dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

Scheduled Site Maintenance

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.

Monday - Friday
12:00AM - 12:30AM

Monday
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... MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are ... Usage: Do not use designation code. this code ... for this service. 5731 200 UNITS ALLOWED PER ROLLING ...
Terms matched: 3  -  Score: 132  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... by an FQHC, regardless of whether the FQHC is the recipient’s designated primary care provider. • MEDICAL services under Managed Care invoice using ...
Terms matched: 1  -  Score: 20  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
... family training that takes place in both the home and office settings? You can designate the training location by using the appropriate Place of Service (POS) code ...
Terms matched: 1  -  Score: 20  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
... codes: • 031: Designated Mobile Crisis Team (DMCT) 87 ... (EVV Required) • 200: Environmental Accessibility Adaptations • ...
Terms matched: 2  -  Score: 67  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... 38, 40-41, 33 and ICN designations; updated requirements for the Claim Appeal ... chapters are: 100: Medicaid Program 200: Hospital Services 300: Radiology Services ...
Terms matched: 2  -  Score: 47  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... 38, 40-41, 33 and ICN designations; updated requirements for the Claim Appeal ... chapters are: 100: Medicaid Program 200: Hospital Services 300: Radiology Services ...
Terms matched: 2  -  Score: 47  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
... of a beneficiary’s physical, behavioral, and health-related social concerns. Designated providers must meet the qualifications outlined in the State Plan and Medicaid Service Manuals ...
Terms matched: 1  -  Score: 23  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
... services and through effective case management and care coordination. CCBHCs may collaborate with a Designated Collaborating Organization (DCO) that is an extension of the CCBHC delivery model ...
Terms matched: 1  -  Score: 23  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... services and through effective case management and care coordination. CCBHCs may collaborate with a Designated Collaborating Organization (DCO) that is an extension of the CCBHC delivery model ...
Terms matched: 1  -  Score: 23  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
... purchase) â€" 1 unit per 3 yrs A4287 Disposable collection and storage 200 units per 30 rolling days bag for breast milk Prior authorization for breast pumps ...
Terms matched: 1  -  Score: 12  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
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