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

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.

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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... limit. Must be provided by licensed SLIDES PREPARED ELSEWHERE pathologist. Must use modifier ... TMJ RECONSTRUCTION 01 NC 01 D7860 TMJ CUTTING INTO JOINT 00 NC 00 D7865 TMJ ...
Terms matched: 2  -  Score: 60  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
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... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... REQUIRED - HDR 383 Length of Stay Cut Back by Date of 252 An attachment ...
Terms matched: 2  -  Score: 42  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... service. Exceptions are Medicare assignment (billing at the Medicare fee schedule), sliding fee schedules that are based on a recipient’s income, contracted ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
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Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
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