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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Known System Issues-Click HERE

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. Known_Issues.pdf
... ) and/or error code 1022-(Referring NPI required) when the ordering NPI is entered appropriately with the “DKâ€qualifier. 84 Claims ...
Terms matched: 1  -  Score: 47  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. New_Provider_Road_Map.pdf
... a new provider. It is recommended to attend the following courses in this suggested order to ensure you get the information and resources you need. Icon Virtual Instructor-Led ...
Terms matched: 1  -  Score: 26  -  21 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/New_Provider_Road_Map.pdf
3. NV_BillingGuidelines_PT43.pdf
... Chapter 800 for the specific criteria that must be met before the tests can be ordered. • CPT codes for biomarker testing for diagnosis, treatment, ...
Terms matched: 1  -  Score: 198  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
4. NV_BillingGuidelines_PT43_20250804.pdf
... Chapter 800 for the specific criteria that must be met before the tests can be ordered. • CPT codes for biomarker testing for diagnosis, treatment, ...
Terms matched: 1  -  Score: 198  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
5. web_announcement_3759_20251107.pdf
... Affordable Care Act) of 2010 (Public Law 111-148): 1. All orders for DMEPOS items as required by CMS, whether verbal or written, must ...
Terms matched: 1  -  Score: 20  -  07 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3759_20251107.pdf
6. Provider_Enrollment_Information_Booklet.pdf
... Nevada Medicaid and Nevada Check Up programs. To bill for services rendered or to order, prescribe, and refer services to Nevada Medicaid recipients (hereafter referred to ...
Terms matched: 1  -  Score: 211  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. web_announcement_3758_20251105.pdf
... . Providers can review Chapter 4: Prior Authorization of the PWP User Manual in order to learn about how to review the status of a PA as well as ...
Terms matched: 1  -  Score: 20  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3758_20251105.pdf
8. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... REF), if present. 1062 ORDERING NPI REQUIRED 1062 Ordering NPI is required ...
Terms matched: 2  -  Score: 165  -  04 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
9. NV_Flex_User_Guide_Individual.pdf
... Welcome and Enrollment Information.... 2 1.2. Provider Information .... 8 1.2.1. Ordering, Prescribing or Referring (OPR) Application or Revalidation Enrollment Type... 14 1.3 ...
Terms matched: 1  -  Score: 94  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
10. NV_Flex_User_Guide_Group.pdf
... organization with which a fiscal agent has entered into a contract, agreement, purchase order, or lease (or leases of real property) to obtain space, ...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
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