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

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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. Error_Code_to_EOB_to_ANSI.pdf
... Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 28  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_Billing_General_20251215.pdf
... the Carson City and rural areas, call (775) 687-5162. For the Las Vegas area, call (702) 486-6200. For the Waiver for the ...
Terms matched: 1  -  Score: 31  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
3. NV_Billing_General.pdf
... the Carson City and rural areas, call (775) 687-5162. For the Las Vegas area, call (702) 486-6200. For the Waiver for the ...
Terms matched: 1  -  Score: 31  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. NV_Billing_General_20251017.pdf
... the Carson City and rural areas, call (775) 687-5162. For the Las Vegas area, call (702) 486-6200. For the Waiver for the ...
Terms matched: 1  -  Score: 31  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
5. Benefit_Enrollment_and_Maintenance_(834).pdf
... LIBRA****34*546217345 N3*7878 RIO GRANDE N4*LAS VEGAS*NV*891300000**CY*002 DMG*D8* ...
Terms matched: 1  -  Score: 29  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
6. NV_Billing_General_20250801.pdf
... the Carson City and rural areas, call (775) 687-5162. For the Las Vegas area, call (702) 486-6200. For the Waiver for the ...
Terms matched: 1  -  Score: 31  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
7. web_announcement_3711_20250904.pdf
... • Nevada Medicaid, 1210 S. Valley View, Suite 104, Las Vegas, Nevada 89102 • Nevada Medicaid, 745 W. Moana ...
Terms matched: 1  -  Score: 51  -  04 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3711_20250904.pdf
8. NV_Billing_General_20250220.pdf
... the Carson City and rural areas, call (775) 687-5162. For the Las Vegas area, call (702) 486-6200. For the Waiver for the ...
Terms matched: 1  -  Score: 31  -  29 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250220.pdf
9. NV_BillingGuidelines_PT29_online_20250318.pdf
... Nevada, the urban regions include Boulder City and the portion of Clark County within Las Vegas Valley Updated 03/18/2025 Provider Type 29 Billing Guide ( ...
Terms matched: 1  -  Score: 50  -  09 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20250318.pdf
10. NV_BillingGuidelines_PT29.pdf
... Nevada, the urban regions include Boulder City and the portion of Clark County within Las Vegas Valley Updated 07/09/2025 Provider Type 29 Billing Guide ( ...
Terms matched: 1  -  Score: 50  -  09 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29.pdf
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