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 for Procedure) on the Web Portal until this issue has been resolved. 50 Claims, Provider The Provider Type 44 Billing Guidelines informs • Provider ...
Terms matched: 1  -  Score: 37  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EnrollmentChecklist_PT93_Spec704.pdf
... and dated, that the bed count is more than 16 beds and more than 50% of care is primarily engaged in providing diagnosis, treatment or care of ...
Terms matched: 1  -  Score: 21  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
3. NV_EnrollmentChecklist_PT93_Spec704_Flex.pdf
... and dated, that the bed count is more than 16 beds and more than 50% of care is primarily engaged in providing diagnosis, treatment or care of ...
Terms matched: 1  -  Score: 20  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704_Flex.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... , that the bed count is more than 16 93 704 beds and more than 50% of care is primarily engaged in Institution for Mental providing diagnosis, treatment ...
Terms matched: 1  -  Score: 11  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. NV_BillingGuidelines_PT14_online_030525.pdf
... of Code Provider Authorization Need Type(s ) Requirement 90846 Family Psychotherapy (without 50 minutes; bill one QMHP, The services must deal with issues relating Yes ...
Terms matched: 1  -  Score: 25  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
6. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic procedures, the ...
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
7. NV_BillingGuidelines_PT14.pdf
... . the Intensity of LMFT, LCPC Needs grid. 90846 Family Psychotherapy (without 50 minutes; bill one QMHP, The services must deal with issues relating Yes ...
Terms matched: 1  -  Score: 23  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
8. NV_BillingGuidelines_PT20-24-77.pdf
... applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic procedures, the ...
Terms matched: 1  -  Score: 14  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
9. 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 50 of 186 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 108  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
10. NV_BillingGuidelines_PT34.pdf
... tissue Required 97605 Negative pressure wound therapy Required 97606 Total wound surface area greater than 50 square Required centimeters 97760 Orthotic(s ) fitting and training, upper extremity ...
Terms matched: 1  -  Score: 26  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
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