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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Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 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. 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 50 of 229 Claim Error/EOB/ ...
Terms matched: 2  -  Score: 108  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. 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  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... that the bed count is more than 16 Institution for Mental beds and more than 50% of care is primarily engaged in Disease (IMD) providing diagnosis, ...
Terms matched: 1  -  Score: 11  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. web_announcement_3757_20251103.pdf
... sprinkle defined as the 15 mg and 25 mg, non-preferred strength defined as the 50 mg • Depakene removed from the PDL due product discontinuation Web Announcement ...
Terms matched: 1  -  Score: 23  -  03 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3757_20251103.pdf
5. web_announcement_3753_20251024.pdf
... Not Health Plan of Nevada Program, $75 Baby Essentials Gift Card, $50 Instacart cart and $25 Healthy Food âœ" 800-962-8074 Card, Gym Membership ...
Terms matched: 1  -  Score: 14  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
6. Benefit_Enrollment_and_Maintenance_(834).pdf
... Reason ... 48 Appendix G: Switch Reason... 49 Appendix H: Enrollment Source ... 50 Appendix I: Change Summary ... 51 Updated 10/20/2025 iv ...
Terms matched: 1  -  Score: 94  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
7. NV_Billing_General_20250801.pdf
... Updated 08/01/2025 Billing Manual Pv02/20/2025 36 o 50 â€" Claim Adjustment Non-Check Related o 51 â€" Adjustments â ...
Terms matched: 1  -  Score: 11  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
8. NV_Billing_General.pdf
... Updated 10/17/2025 Billing Manual Pv08/01/2025 36 o 50 â€" Claim Adjustment Non-Check Related o 51 â€" Adjustments â ...
Terms matched: 1  -  Score: 11  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. NV_EVS_User_Manual_Ch3.pdf
... asterisk (* ) are required fields. Service Details • Up to 50 service details to be added to a dental claim • Procedure codes ...
Terms matched: 1  -  Score: 63  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
10. NV_EVS_User_Manual_Ch1.pdf
... as a delegate, Trading Partner or MCO... 48 1.8.1. Inactive Delegate Accounts ... 50 1.8.2. Switching providers as a delegate ... 51 1.9. Forgot user ID ...
Terms matched: 1  -  Score: 32  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
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