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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

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1. Known_Issues.pdf
... units on the PA will be adjusted. 188 Claims, Claims submitted by provider types 24-(Advanced • Providers: No additional action 07/ ...
Terms matched: 1  -  Score: 464  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EVS_User_Manual_Ch3.pdf
... status. For provider specific billing information refer to the Billing Guidelines (by Provider Type) . 3.1 Submit Claim The Claims tab provides the ability to submit dental ...
Terms matched: 1  -  Score: 401  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
3. NV_BillingGuidelines_PT14_online_011226.pdf
... Provider Type 14 Billing Guide Behavioral Health Outpatient Treatment State policy The Medicaid Services ... ) . • MSM Chapter 400 covers policy for behavioral health providers. ...
Terms matched: 2  -  Score: 508  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
4. NV_BillingGuidelines_PT14.pdf
... Provider Type 14 Billing Guide Behavioral Health Outpatient Treatment State policy The Medicaid Services ... ) . • MSM Chapter 400 covers policy for behavioral health providers. ...
Terms matched: 2  -  Score: 494  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
5. NV_BillingGuidelines_PT26.pdf
... Provider Type 26 Billing Guide Psychologist Outpatient mental health services rendered by a psychologist ... Medicaid Services Manual (MSM) Chapter 400 provides complete coverage and limitations for each ...
Terms matched: 2  -  Score: 219  -  13 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26.pdf
6. NV_BillingGuidelines_PT26_20260112.pdf
... Provider Type 26 Billing Guide Psychologist Outpatient mental health services rendered by a psychologist ... Medicaid Services Manual (MSM) Chapter 400 provides complete coverage and limitations for each ...
Terms matched: 2  -  Score: 219  -  13 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20260112.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are ... eligible to N95 This provider type/provider specialty may ... ), if present. 400 DETAIL UNITS OF SERVICE ...
Terms matched: 3  -  Score: 466  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. Provider_Enrollment_Information_Booklet.pdf
... Information .... 1 Nevada Medicaid Provider Types and Specialties .... 1 Table 1 ... Health Outpatient Treatment Group • 400*: Ordering, Prescribing, Referring ...
Terms matched: 2  -  Score: 666  -  09 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
9. web_announcement_3820_20260120.pdf
... 2026 (Updated February 6, 2026) Nevada Medicaid Web Announcement 3820 Attention Provider Type (PT) 19 (Nursing Facilities) and Hospitals under PTs 10, ...
Terms matched: 1  -  Score: 21  -  06 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3820_20260120.pdf
10. web_announcement_3822_20260123.pdf
... 00 p.m. to 2:30 p.m. (DME) Workshop (Provider Type 33) Submitting Secondary Claims Thursday February 12, 2026 10:00 a.m ...
Terms matched: 1  -  Score: 51  -  05 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3822_20260123.pdf
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