Nevada Medicaid and Nevada Check Up News (Second Quarter 2026 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

IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims. See Web Announcement 3983.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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.

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
8:00PM - 12:00AM

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... exceptions to policy limitations for medical necessity in exceptional cases. Billing Reimbursement Submission Instructions Fee for Service Recipients Dental services provided to Medicaid Fee for Services (FFS) ...
Terms matched: 1  -  Score: 70  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
... rural Nevada: Dental services provided in rural areas of Nevada are billed under the Fee for Service (FFS) benefit plan. Orthodontic services are billed under the ...
Terms matched: 1  -  Score: 35  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20230327.pdf
... 000 annual calendar year expenditure limit will be calculated using the Fee-for-Service (FFS) Fee Schedule for Provider Type 22 - Dentists, using the reimbursement rates for the ...
Terms matched: 1  -  Score: 62  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
... ) for all qualified Medicaid visits and the payments the FQHC would have received for fee- for-service (FFS) Medicaid recipients receiving the same services. This concept ...
Terms matched: 1  -  Score: 41  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260306.pdf
... . Prior Authorization SHS do not require prior authorization. See the Provider Type 60 Fee Schedule for a list of available procedure codes. Third Party Liability (TPL ...
Terms matched: 1  -  Score: 91  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... . Prior Authorization SHS do not require prior authorization. See the Provider Type 60 Fee Schedule for a list of available procedure codes. Third Party Liability (TPL ...
Terms matched: 1  -  Score: 91  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
... available on the Provider Web Portal https://www.medicaid.nv.gov/ through the Search Fee Schedule function, which can be accessed on the Provider Login webpage under Resources ...
Terms matched: 1  -  Score: 26  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT97_2025-1001.pdf
... available on the Provider Web Portal https://www.medicaid.nv.gov/ through the Search Fee Schedule function, which can be accessed on the Provider Login webpage under Resources ...
Terms matched: 1  -  Score: 26  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT97.pdf
... 98960 Educ/training for self-management 59840 - 59841 Induced abortion Q3014 Telehealth originating site fee 59866 Multifetal pregnancy reductions S9445 Patient education, non physician Updated 05/15 ...
Terms matched: 1  -  Score: 20  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Instructions.pdf
... Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) ... Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information ...
Terms matched: 2  -  Score: 55  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
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