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]

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

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
... MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are ... /08/2025 Page 10 of 229 Claim Error ... /08/2025 Page 15 of 229 Claim Error ...
Terms matched: 3  -  Score: 566  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... an 00 unlimited number of photos Updated 10/06/2025 pv 12/ ... sedation/analgesia â€" first 15 minutes D9243 Intravenous moderate conscious 4 units ...
Terms matched: 2  -  Score: 102  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
3. NV_BillingGuidelines_PT22-attachmentB.pdf
... Updated 12/08/2025 pv 10/06/2025 Attachment B Page ... sedation/analgesia â€" first 15 minutes D9243 Intravenous moderate conscious 4 units ...
Terms matched: 2  -  Score: 95  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
4. FA-11E.pdf
... Page 1 of 9 Updated 06/10/2025 (pv12/20/ ... , face-to-face with one patient, each 15 minutes Adaptive behavior treatment with protocol modification ...
Terms matched: 2  -  Score: 252  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
5. Known_Issues.pdf
... €¢ Provider: No additional action 10/03/2025 TBD TBD Authorization ... be adjusted to pay the Development, 15 minutes) were paying an correct rate ...
Terms matched: 2  -  Score: 605  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
6. web_announcement_3766_20251112.pdf
... November 12, 2025 Nevada Medicaid Web Announcement 3766 Attention Provider Type 10 (Outpatient Surgery, Hospital Based): Reminder of Prior Authorization Requirement for Procedure Code ...
Terms matched: 1  -  Score: 42  -  12 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3766_20251112.pdf
7. web_announcement_3765_20251112.pdf
... Prosthetics, Orthotics and Disposable Medical Supplies): Prior Authorization Requirements Updated Effective November 10, 2025, the following go-forward changes have been implemented for provider type 33 ...
Terms matched: 1  -  Score: 42  -  12 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3765_20251112.pdf
8. web_announcement_3764_20251112.pdf
... 188 (Certified Community Behavioral Health Centers): Prior Authorization Requirements Updated Effective November 10, 2025, the Medicaid Management Information System (MMIS) has been corrected ...
Terms matched: 1  -  Score: 20  -  12 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3764_20251112.pdf
9. web_announcement_3763_20251110.pdf
... November 10, 2025 Nevada Medicaid Web Announcement 3763 Attention Provider Type (PT) 82 (Behavioral Health Rehabilitative Treatment): Sunsetting Provider Type Provider type ( ...
Terms matched: 1  -  Score: 26  -  10 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3763_20251110.pdf
10. web_announcement_3762_20251110.pdf
... November 10, 2025 Nevada Medicaid Web Announcement 3762 Attention Provider Type 17 (Special Clinics) Specialty 180 (Rural Health Clinic): Error Code 5052 Updated ...
Terms matched: 1  -  Score: 49  -  10 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3762_20251110.pdf
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