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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

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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1. Error_Code_to_EOB_to_ANSI.pdf
... REMARK_CODE_DESCRIPTION 247 MAXIMUM NUMBER OF CLAIM DETAILS 5310 The detail lines are missing or the ... has M54 Missing/incomplete/invalid total charges. submission/billing error( ...
Terms matched: 2  -  Score: 230  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. ABA_FAQ.pdf
... maximum number of units that can be used for supervision is 20% of the total number of hours of direct therapy services provided. Is the FA-11F only required ...
Terms matched: 1  -  Score: 20  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
3. NV_BillingGuidelines_PT25-41.pdf
... width over 28mm) • V2320 (Trifocal add over 3.25d) A total of 2 units using any combination of the above bifocal/trifocal width codes ...
Terms matched: 1  -  Score: 64  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41.pdf
4. NV_Billing_General.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
5. NV_Billing_General_20260101.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
6. Known_Issues.pdf
... the following edits on the Web Portal: • 270-(Header Total Billed Amount Missing) • 508-(HDR Billed AMT Not ...
Terms matched: 1  -  Score: 28  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
7. NV_EVS_User_Manual_Ch3.pdf
... Information panel will appear on the Submit Dental Claim: Step 2 • Total Charged Amount â€" Read only and displays the total charge amount associated ...
Terms matched: 1  -  Score: 93  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
8. NV_BillingGuidelines_PT14.pdf
... based on the calendar year, beginning January 1. These limits are a combined total of all sessions used for the following procedure codes: • 90832 ...
Terms matched: 1  -  Score: 14  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
9. NV_BillingGuidelines_PT22-attachmentA.pdf
... D7945 BONE CUTTING BODY MANDIBLE 01 01 01 Once in a lifetime D7946 RECONSTRUCTION MAXILLA TOTAL 01 01 01 Once in a lifetime D7947 RECONSTRUCT MAXILLA SEGMENT 01 01 01 ...
Terms matched: 1  -  Score: 12  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
10. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... determine payment for the unrelated endoscopy, the multiple surgery rules are applied. The total payment for the related endoscopies is considered one service and the unrelated endoscopy is ...
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
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