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 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
... . 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 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. FA-11E.pdf
... voluminous documentation will not be reviewed. Focused Comprehensive Start Date and End Date Required Total Units Code Code Description (May request up to 180 days, Units Per ...
Terms matched: 1  -  Score: 20  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
3. 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  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
4. NV_Flex_User_Guide_Group.pdf
... interest means a person or corporation that: • Has an ownership interest totaling five (5 ) percent or more in a disclosing entity, †...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
5. NV_Flex_User_Guide_Individual.pdf
... interest means a person or corporation that: • Has an ownership interest totaling five (5 ) percent or more in a disclosing entity, †...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
6. Benefit_Enrollment_and_Maintenance_(834).pdf
... Comments # 496 SE Transaction Set Trailer 496 SE01 Transaction Segment Count 1/10 Total number of segments included in a transaction set including ST and SE segments. ...
Terms matched: 1  -  Score: 69  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
7. 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  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
8. NV_Billing_General_20250801.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  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
9. 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 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
10. NV_EVS_User_Manual_Ch5.pdf
... is blank Check#/RA# â€" Check number and RA number Total Paid Amount â€" Amount of payment made to provider RA Copy ( ...
Terms matched: 1  -  Score: 20  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch5.pdf
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