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

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.

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1. NV_BillingGuidelines_PT22-attachmentA.pdf
... /02/2026 Attachment A Page 10 of 15 Service for Persons Service for ... /2026 Attachment A Page 1 of 15 Service for Persons Service for Persons Pregnancy-Related ...
Terms matched: 2  -  Score: 161  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_BillingGuidelines_PT22-attachmentB.pdf
... Intravenous moderate conscious 1 unit per day 00 sedation/analgesia â€" first 15 minutes D9243 Intravenous moderate conscious 4 units per day sedation/analgesia †...
Terms matched: 1  -  Score: 24  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
3. Known_Issues.pdf
... €¢ Provider: No additional action 10/03/2025 12/15 ... 2025 TBD Authorization equivalent to the allowed quantity submitted on the claim; needed. ...
Terms matched: 2  -  Score: 612  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
4. NV_EnrollmentCriteria_PT17_Spec188.pdf
... 9. Complete a Readiness Tool. 10. Complete a Needs Assessment. 11 ... CCBHC Personnel Checklist and staffing plan. 15. Develop a Policy and Procedure Manual ...
Terms matched: 2  -  Score: 39  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
5. Provider_Enrollment_Information_Booklet.pdf
... and Specialties Outpatient Surgery, Hospital Based 10 Specialty type code: • ... Directives and Civil Rights Compliance .... 15 Provider Groups Allowing Linkage .... 15 ...
Terms matched: 2  -  Score: 216  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. NV_EVS_User_Manual_Ch10.pdf
... Report Download PWP User Manual, Chapter 10 Updated 01/21/2026 ( ... 13 10.2.7 False Claims Act Letters ... 15 10.3 Access Help Page... 17 10.4 Tips ...
Terms matched: 2  -  Score: 115  -  21 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch10.pdf
7. NV_BillingGuidelines_PT14_online_030525.pdf
... counseling visit, intensive, greater than 10 minutes) may be used to bill ... ) services: Submit no more than 15 business days before and no more than ...
Terms matched: 2  -  Score: 340  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
8. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... €œBilling Referenceâ€) . Updated 10/13/2025 Provider Type 20 ... Nutrition Therapy services are reimbursable under PT 15 (Registered Dietitian) . Please refer ...
Terms matched: 2  -  Score: 186  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
9. NV_BillingGuidelines_PT26_20251013.pdf
... counseling visit, intensive, greater than 10 minutes) may be used to bill ... OMH): Submit no more than 15 business days before and no more than ...
Terms matched: 2  -  Score: 135  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20251013.pdf
10. NV_BillingGuidelines_PT14.pdf
... counseling visit, intensive, greater than 10 minutes) may be used to bill ... ) services: Submit no more than 15 business days before and no more than ...
Terms matched: 2  -  Score: 316  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
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