Nevada Medicaid and Nevada Check Up News (Second Quarter 2026 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]

Notifications

IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for September 2026 Professional Claims. See Web Announcement 4031.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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 https://NevadaMedicaid.nv.gov/ and the Billing Guide for your provider type at www.medicaid.nv.gov.

Scheduled Site Maintenance

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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... payment source • Ensures an individual is placed appropriately in the least restrictive setting possible • Ensures an individual also receives specialized services if needed for ...
Terms matched: 1  -  Score: 16  -  27 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PASRR_LOC_NF_Training_2021.pdf
... the Authorization Criteria Search Function. Prior Authorization Requirements for the Outpatient/Surgical Center Setting: For Medicaid recipients ages 5 and under or ages 21 and older: ...
Terms matched: 1  -  Score: 39  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Dental_Outpatient_PA_Tip_Sheet.pdf
... please review the Authorization Criteria Search Function. Prior Authorization Requirements for the Inpatient Hospital Setting: Prior authorization is required for dental procedures that require inpatient hospitalization. Prior ...
Terms matched: 1  -  Score: 37  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Dental_Inpatient_PA_Tip_Sheet.pdf
... Related Questions Can other users in our office Yes. The provider/administrator who set up the account can grant access to what is access PWP? called a ...
Terms matched: 1  -  Score: 21  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/EVS_FAQ.pdf
... the feasibility of meeting the recipient’s medical needs in the home health setting. When personnel of the HHA make an initial visit to assess the recipient ...
Terms matched: 1  -  Score: 20  -  23 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT29_PA_FAQ.pdf
... for: • Following regulations set forth in the Medicaid Services Manual ( ... Services. Providers should now call the customer service center with any questions rather than ...
Terms matched: 2  -  Score: 95  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... for: • Following regulations set forth in the Medicaid Services Manual ( ... Services. Providers should now call the customer service center with any questions rather than ...
Terms matched: 2  -  Score: 95  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
... • Prior authorization for dental procedures performed in an outpatient/surgical center setting may require prior authorization. • Use the ADA Claim Form and ...
Terms matched: 1  -  Score: 60  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
... • Prior authorization for dental procedures performed in an outpatient/surgical center setting may require prior authorization. • Use the ADA Claim Form and ...
Terms matched: 1  -  Score: 60  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20260701.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Covered services The following services are considered Community ...
Terms matched: 1  -  Score: 23  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_249_online_20260727.pdf
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