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. Known_Issues.pdf
... rule) and 4871-(Claim type restriction on proc billing table) . 100 Claims, Some Provider Type 22-(Dentist) are being †...
Terms matched: 1  -  Score: 11  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EnrollmentChecklist_PT93_Spec704.pdf
... _____ Policy Declaration I hereby declare that I have read the current MSM Chapters 100, 400, 3300 and 4100 as of the date above and understand this ...
Terms matched: 1  -  Score: 84  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
3. NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... MSM Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains important information applicable to all provider types. Authorization Requirements All services must ...
Terms matched: 1  -  Score: 38  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
4. NV_BillingGuidelines_PT17_Spec188.pdf
... MSM Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains important information applicable to all provider types. Authorization Requirements All services must ...
Terms matched: 1  -  Score: 38  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
5. Provider_Enrollment_Information_Booklet.pdf
... also published on the following website at https://dhcfp.nv.gov. MSM Chapter 100 contains specific enrollment requirements. General Information Enrollment requirements vary depending on provider type ...
Terms matched: 1  -  Score: 85  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. NV_BillingGuidelines_PT14_online_030525.pdf
... MSM Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed ...
Terms matched: 1  -  Score: 16  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
7. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... endoscopy rules are applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic ...
Terms matched: 1  -  Score: 14  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
8. NV_BillingGuidelines_PT14.pdf
... MSM Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed ...
Terms matched: 1  -  Score: 14  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
9. NV_BillingGuidelines_PT20-24-77.pdf
... endoscopy rules are applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic ...
Terms matched: 1  -  Score: 14  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
10. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... : 01/07/2026 Page 100 of 186 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 49  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
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