Nevada Medicaid and Nevada Check Up News (Second 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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IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims. See Web Announcement 3983.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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. NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
... WITH FIELD OF 00 00 00 1 service unit per 36 months VIEW OF ONE FULL DENTAL ARCH - MANDIBLE D0382 CONE BEAM CT IMAGE CAPTURE WITH FIELD OF 00 ...
Terms matched: 1  -  Score: 82  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
2. NV_BillingGuidelines_PT22-attachmentA.pdf
... WITH FIELD OF 00 00 00 1 service unit per 36 months VIEW OF ONE FULL DENTAL ARCH - MANDIBLE D0382 CONE BEAM CT IMAGE CAPTURE WITH FIELD OF 00 ...
Terms matched: 1  -  Score: 82  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
3. NV_BillingGuidelines_PT22.pdf
... Periodic Screening, Diagnosis and Treatment (EPSDT) Program are eligible to receive the full range of dental care without authorization, with the exception of orthodontics which requires ...
Terms matched: 1  -  Score: 33  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
4. NV_BillingGuidelines_PT17_Spec181.pdf
... individual CDT/CPT/HCPCS code services performed. • Deny (Full Claim) â€" Audit 5751 will post for claims amounts when no ...
Terms matched: 1  -  Score: 23  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
5. NV_BillingGuidelines_PT60_2026-0429.pdf
... for each screening. NOTE: A screening may also be a component of a full assessment, but only the full assessment (including a CASII or LOCUS) ...
Terms matched: 1  -  Score: 173  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
6. NV_BillingGuidelines_PT60.pdf
... for each screening. NOTE: A screening may also be a component of a full assessment, but only the full assessment (including a CASII or LOCUS) ...
Terms matched: 1  -  Score: 173  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. Pregnancy_Presumptive_Eligibility_Instructions.pdf
... client attestation) . Presumptive eligibility allows the pregnant person to apply for continued and full Medicaid coverage while beginning prenatal care immediately. Pregnancy presumptive eligibility is limited to ...
Terms matched: 1  -  Score: 47  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Instructions.pdf
8. Pregnancy_Presumptive_Eligibility_Addendum.pdf
... Assist a minimum of 90% of the individuals determined presumptively eligible with completing a full electronic Medicaid application. 1.6 Maintain PE applications and supporting documentation for a period ...
Terms matched: 1  -  Score: 21  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Addendum.pdf
9. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
10. Known_Issues.pdf
... patient • Claims are being reviewed for possible Claims liability amount deducted in full for a member further action. within the same month, for more than ...
Terms matched: 1  -  Score: 22  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
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