Nevada Medicaid and Nevada Check Up News (Third 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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Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

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. Error_Code_to_EOB_to_ANSI.pdf
... . 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... 9999 Processed Per Policy 45 Charge exceeds fee schedule/maximum N130 Consult plan benefit ...
Terms matched: 2  -  Score: 153  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Known_Issues.pdf
... to an instance of an object in place. 10 Web Portal, The Search Fee Schedule and Prior Authorization • Provider: Users can now use the ...
Terms matched: 1  -  Score: 120  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_BillingGuidelines_PT43_20250804.pdf
... nurse practitioner. The following list of covered services is provided for your convenience. Fee schedules are located on the Nevada Medicaid Rate Setting webpage at http:/ ...
Terms matched: 1  -  Score: 131  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
4. NV_BillingGuidelines_PT43.pdf
... nurse practitioner. The following list of covered services is provided for your convenience. Fee schedules are located on the Nevada Medicaid Rate Setting webpage at http:/ ...
Terms matched: 1  -  Score: 131  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
5. web_announcement_3753_20251024.pdf
... mental health apps. CareSource Sams Club Annual Membership, Boys and Girls Club Annual Fee, Pack and Play or Car Seat for Pregnant Members, Postpartum Home Delivered ...
Terms matched: 1  -  Score: 14  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
6. Benefit_Enrollment_and_Maintenance_(834).pdf
... empl hlth plan) 13 Failure to respond 14 Failure to pay premium or enrollment fees 15 Moved to a different state 16 Voluntary request for termination 17 Lack of ...
Terms matched: 1  -  Score: 10  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
7. NV_Billing_General.pdf
... eligibility .... 16 Termination of eligibility.... 16 Sample Medicaid card .... 16 Fee For Service vs. Managed Care .... 17 MCO contact information.... 17 ...
Terms matched: 1  -  Score: 132  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
8. NV_Billing_General_20250801.pdf
... eligibility .... 16 Termination of eligibility.... 16 Sample Medicaid card .... 16 Fee For Service vs. Managed Care .... 17 MCO contact information.... 17 ...
Terms matched: 1  -  Score: 132  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
9. NV_EVS_User_Manual_Ch6.pdf
... Provider Web Portal (PWP) User Manual Chapter Six: Search Fee Schedule PWP User Manual, Chapter 6 Updated 10/17/2025 (pv09/ ...
Terms matched: 1  -  Score: 297  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch6.pdf
10. NV_EVS_User_Manual_Ch2.pdf
... Arrangement Coverage section. 5 6 5 Under coverage, the detail may display Medicaid Fee For Service or Nevada Check Up. This verifies that the recipient is eligible ...
Terms matched: 1  -  Score: 101  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch2.pdf
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