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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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. Error_Code_to_EOB_to_ANSI.pdf
... . 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... : 12/08/2025 Page 100 of 229 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 49  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. 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  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_BillingGuidelines_PT43_20250804.pdf
... webpage) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter ...
Terms matched: 1  -  Score: 26  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
4. NV_BillingGuidelines_PT43.pdf
... webpage) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter ...
Terms matched: 1  -  Score: 26  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
5. web_announcement_3760_20251110.pdf
... claims, including those denied upon reprocessing. Please refer to Medicaid Services Manual Chapter 100 and the Billing Manual for information concerning the claim appeal process and time frames ...
Terms matched: 1  -  Score: 20  -  10 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3760_20251110.pdf
6. 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  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. web_announcement_3755_20251027.pdf
... claims, including those denied upon reprocessing. Please refer to Medicaid Services Manual Chapter 100 and the Billing Manual for information concerning the claim appeal process and time frames ...
Terms matched: 1  -  Score: 20  -  27 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3755_20251027.pdf
8. web_announcement_3753_20251024.pdf
... 844-396-2329 GED, HISet tests, industry certification, money for work clothes; $100 gym ChooseAnthem.com/nv membership & Weight Watchers voucher; online fitness & mental ...
Terms matched: 1  -  Score: 29  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
9. Benefit_Enrollment_and_Maintenance_(834).pdf
... initiative of Council for Affordable Quality Healthcare, CORE is a committee of more than 100 industry leaders who help create and promulgate a set of voluntary business rules focused ...
Terms matched: 1  -  Score: 11  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
10. NV_Billing_General.pdf
... forth in the Medicaid Services Manual (see Medicaid Services Manual (MSM) Chapter 100 Medicaid Program and MSM Chapter 3300 Program Integrity) • Obtaining prior ...
Terms matched: 1  -  Score: 98  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
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