Nevada Medicaid and Nevada Check Up News (First Quarter 2026 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 April 2026 Professional Claims. See Web Announcement 3915.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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 https://NevadaMedicaid.nv.gov/ and the Billing Guide for your provider type at www.medicaid.nv.gov.

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1. FA-11.pdf
... . FA-11 Page 1 of 4 Updated 04/09/2026 (pv12/15/2025) Nevada Medicaid and Nevada Check Up Behavioral Health Outpatient or Rehabilitative ...
Terms matched: 1  -  Score: 73  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
2. Known_Issues.pdf
... needed. 2/2 /2019 10/7 /2019 2/19 ... be adjusted to pay the Development, 15 minutes) were paying an correct rate ...
Terms matched: 2  -  Score: 612  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are ... /05/2026 Page 10 of 185 Claim Error ... /05/2026 Page 15 of 185 Claim Error ...
Terms matched: 3  -  Score: 566  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... Review by emailing nvpeer_to_peer@gainwelltechnologies.com within 10 calendar days of the adverse determination. ... authorization period is 05/11/15 through 05/15/15, ...
Terms matched: 2  -  Score: 81  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. NV_BillingGuidelines_PT11.pdf
... Review by emailing nvpeer_to_peer@gainwelltechnologies.com within 10 calendar days of the adverse determination. ... authorization period is 05/11/15 through 05/15/15, ...
Terms matched: 2  -  Score: 81  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
6. NV_BillingGuidelines_PT60.pdf
... Guide pv 12/16/2025 10 / 78 Provider Type 60 Billing Guide ... their description, e.g., each 15 minutes or each 30 minutes, each ...
Terms matched: 2  -  Score: 464  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. NV_BillingGuidelines_PT60_2025-1216.pdf
... Guide pv 08/28/2024 10 / 78 Provider Type 60 Billing Guide ... their description, e.g., each 15 minutes or each 30 minutes, each ...
Terms matched: 2  -  Score: 464  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
8. web_announcement_3891_20260410.pdf
... April 10, 2026 (Updated April 27, 2026) Nevada Medicaid Web Announcement 3891 Attention Electronic Visit Verification (EVV) Providers: Claims That Denied Will ...
Terms matched: 1  -  Score: 49  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3891_20260410.pdf
9. web_announcement_3897_20260421.pdf
... to 2:30 p.m. Submitting Secondary Claims - Thursday May 7, 2026 10:00 a.m. to 11:00 a.m. Professional Enrollment Overview for ...
Terms matched: 1  -  Score: 52  -  22 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3897_20260421.pdf
10. 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  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
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