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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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 https://NevadaMedicaid.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
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... /similar procedure within set time COORDINATOR frame. 3353 SPECIALIZED FOSTER CARE CHECKLIST 3352 ...
Terms matched: 2  -  Score: 311  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT25-41.pdf
... ¢ Ocular prosthesis • Vision therapy • Qualifying eyeglass lenses and frames with a prescription • Polycarbonate lenses See MSM Chapter 1100 on the ...
Terms matched: 1  -  Score: 108  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41.pdf
3. NV_BillingGuidelines_PT25-41_20241218.pdf
... ¢ Ocular prosthesis • Vision therapy • Qualifying eyeglass lenses and frames with a prescription • Polycarbonate lenses See MSM Chapter 1100 on the ...
Terms matched: 1  -  Score: 108  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41_20241218.pdf
4. NV_Billing_General_20260101.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  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
5. 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  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
6. NV_EVS_User_Manual_Ch1.pdf
... Gaining access to PWP first requires accessing the Nevada Medicaid Provider website. The top frame of the website contains a menu of tabs for main website content. Menu ...
Terms matched: 1  -  Score: 27  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
7. Known_Issues.pdf
... 20/2019 7/29/2019 8/9 /2019 Professional (Frames, purchases), V2107-(Spherocylinder, • Once resolved ...
Terms matched: 1  -  Score: 11  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
8. 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
9. 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
10. 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
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