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
Phone: 1-877-638-3472

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. Known_Issues.pdf
... 20/2019 7/29/2019 8/9 /2019 Professional (Frames, purchases), V2107-(Spherocylinder, • Once resolved ...
Terms matched: 1  -  Score: 11  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EnrollmentChecklist_PT93_Spec704.pdf
... on your enrollment application, you are required to notify Nevada Medicaid within the time frame established in MSM Chapter 100, Section 103.3(A ) . Changes or ...
Terms matched: 1  -  Score: 36  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... similar procedure within set CARE COORDINATOR time frame. 3353 SPECIALIZED FOSTER CARE CHECKLIST 3352 ...
Terms matched: 2  -  Score: 311  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_Billing_General_20251017.pdf
... revisions; added prior authorization appeals mailing address 07/01/2015 Retroeligibility time frame changed from five days to ten days; 22 and 23 updated instructions under ...
Terms matched: 1  -  Score: 99  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
5. NV_Billing_General_20251215.pdf
... revisions; added prior authorization appeals mailing address 07/01/2015 Retroeligibility time frame changed from five days to ten days; 22 and 23 updated instructions under ...
Terms matched: 1  -  Score: 99  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
6. NV_Billing_General.pdf
... revisions; added prior authorization appeals mailing address 07/01/2015 Retroeligibility time frame changed from five days to ten days; 22 and 23 updated instructions under ...
Terms matched: 1  -  Score: 99  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_BillingGuidelines_PT60.pdf
... field analyzer full threshold programs 30-2, 24-2, or 30/60-2) V2020 Frames, purchases. • Encounter = 1 unit • Limit ...
Terms matched: 1  -  Score: 10  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
8. NV_BillingGuidelines_PT60_2024-0828.pdf
... field analyzer full threshold programs 30-2, 24-2, or 30/60-2) V2020 Frames, purchases. • Encounter = 1 unit • Limit ...
Terms matched: 1  -  Score: 10  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
9. FA-11B.pdf
... SECTION VIII. TREATMENT PLAN Provide goals, interventions, expected outcomes, and time frames. SECTION IX. SIGNIFICANT LIFE EVENTS AND FAMILY HISTORY Provide significant life events ...
Terms matched: 1  -  Score: 20  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11B.pdf
10. web_announcement_3760_20251110.pdf
... Chapter 100 and the Billing Manual for information concerning the claim appeal process and time frames. ...
Terms matched: 1  -  Score: 20  -  10 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3760_20251110.pdf
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