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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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 2026, for scheduled maintenance:
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  • Gabby®, which includes:
    • Gainwell Technologies Contact Center (877) 638-3472
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  • Real time CAQH/CORE EDI eligibility and claim verification
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    • Known System Issues-Click HERE

    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    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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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.

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1. Error_Code_to_EOB_to_ANSI.pdf
... Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 28  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT60.pdf
... D9210 Local anesthesia not in conjunction with operative or surgical procedures. D9212 Trigeminal division block anesthesia. D9215 Local anesthesia in conjunction with operative or surgical procedures. D9222 ...
Terms matched: 1  -  Score: 10  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
3. NV_BillingGuidelines_PT60_2025-1216.pdf
... D9210 Local anesthesia not in conjunction with operative or surgical procedures. D9212 Trigeminal division block anesthesia. D9215 Local anesthesia in conjunction with operative or surgical procedures. D9222 ...
Terms matched: 1  -  Score: 10  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
4. NV_BillingGuidelines_PT22-attachmentA.pdf
... per 60 months D9210 DENT ANESTHESIA W/O SURGERY 00 00 00 D9212 TRIGEMINAL BLOCK ANESTHESIA 00 00 00 D9215 LOCAL ANESTHESIA 00 00 00 D9222 DEEP SEDAT/ ...
Terms matched: 1  -  Score: 12  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
5. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... per 60 months D9210 DENT ANESTHESIA W/O SURGERY 00 00 00 D9212 TRIGEMINAL BLOCK ANESTHESIA 00 00 00 D9215 LOCAL ANESTHESIA 00 00 00 D9222 DEEP SEDAT/ ...
Terms matched: 1  -  Score: 12  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
6. NV_BillingGuidelines_PT60_2024-0828.pdf
... D9210 Local anesthesia not in conjunction with operative or surgical procedures. D9212 Trigeminal division block anesthesia. D9215 Local anesthesia in conjunction with operative or surgical procedures. D9222 ...
Terms matched: 1  -  Score: 10  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
7. web_announcement_3731_20250926.pdf
... , 2025, the First Circuit Court of Appeals removed the previous preliminary injunctions that blocked immediate implementation of this section. Therefore, Nevada Medicaid issues the following guidance ...
Terms matched: 1  -  Score: 23  -  26 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3731_20250926.pdf
8. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
9. Inhaled Antimuscarinics 2012 12.pdf
... - - - ï increased Elevated heart rate - - - ï First degree atrioventricular block <1 - - - Heart failure <1 - - - Hypertension - ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Antimuscarinics%202012%2012.pdf
10. Inhaled Anticholinergics.pdf
... - First degree - - <1 - - - - - - - atrioventricular block Heart failure <1 - - - - - - - - - Hypertension ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Anticholinergics.pdf
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