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]

Notifications

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 November 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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... . 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... 319 Diagnosis not allowed for abortion CPTs 80 PROCEDURE CODE NOT PAYABLE WITH 11 The ...
Terms matched: 2  -  Score: 65  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... part of another procedure 00 tissue D7910 Suture of recent small wounds up to 5 cm 00 None D7961 Buccal / Labial Frenectomy (Frenulectomy) 00 Three in a ...
Terms matched: 1  -  Score: 12  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
... part of another procedure 00 tissue D7910 Suture of recent small wounds up to 5 cm 00 None D7961 Buccal / Labial Frenectomy (Frenulectomy) 00 Three in a ...
Terms matched: 1  -  Score: 12  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... EVS. Request Type: • Initial Prior Authorization: o Check this box if the recipient has not been previously treated by the agency. o For ...
Terms matched: 1  -  Score: 92  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E-I.pdf
... Nursing Facilities must have at least one payable accommodation revenue code on the claim. 80 Claims, Dental Some dental claims are being denied incorrectly • Provider ...
Terms matched: 1  -  Score: 22  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... current This is the location where services are rendered and cannot be a post office box, gated community, or virtual address . Each service address for an organization ...
Terms matched: 1  -  Score: 10  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... comes to you in the mail to NV Medicaid, MCO Changes, P.O. Box 30042, Reno, NV 89520. Please include all household members’ ...
Terms matched: 1  -  Score: 12  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
... a Specialty.â€A pop-up box will display the available ... and Enrollment Information.... 2 1.2. Provider Information ... ... in a corporation that owns 80 percent of the stock ...
Terms matched: 3  -  Score: 88  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
... A Specialty.â€A pop-up box will display the available ... Enrollment Information .... 2 1.2. Provider Information ... ... 2025) corporation that owns 80 percent of the stock ...
Terms matched: 3  -  Score: 76  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
... correspondence: Nevada Medicaid PO Box 30042 Reno, Nevada ... 1.1 Scope .... 2 1.2 Overview.... 2 1.3 ... 1 4 = Monthly Code 80 2100A ICM02 Member Income ...
Terms matched: 3  -  Score: 78  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
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