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
... invalid diagnosis or FORMAT service reported. condition. 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the maximum 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 28  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_Billing_General_20250801.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 22  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
3. NV_Billing_General.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 22  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. NV_EVS_User_Manual_Ch1.pdf
... an available provider, Dr. David Green. By checking on David Green, ... ¢ Office Administrator • Clearing House • Health Maintenance †...
Terms matched: 2  -  Score: 35  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
5. NV_EVS_User_Manual_Ch5.pdf
... . Code Description ACH Electronic payment was made to the provider through an Automated Clearing House (ACH) . CHK A live check was issued for payment. FWT ...
Terms matched: 1  -  Score: 20  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch5.pdf
6. web_announcement_3711_20250904.pdf
... ://www.pahrumplibrary.org/ Henderson District Public Library Pershing County Library 280 S. Green Valley Parkway 1125 Central Avenue Henderson, NV 89012 Lovelock, NV 89419-0781 https ...
Terms matched: 1  -  Score: 20  -  04 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3711_20250904.pdf
7. NV_BillingGuidelines_PT11.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 12  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
8. NV_BillingGuidelines_PT11_online_050625.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 12  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_050625.pdf
9. NV_Billing_General_20250220.pdf
... the request to Nevada Medicaid. • If the patient is still in house, Nevada Medicaid reviews the request in the same time frame as any other ...
Terms matched: 1  -  Score: 22  -  29 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250220.pdf
10. FA-18.pdf
... two years.) Supportive living due to MIâ€"dates: ____ Housing intervention due to MIâ€"dates: ____ Legal intervention due to ...
Terms matched: 1  -  Score: 21  -  16 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-18.pdf
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