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]

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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 June 2026 Professional Claims. See Web Announcement 3964.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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.

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1. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... Service Payment Information REF), if present. 376 4TH OTHER ICD PROCEDURE DATE 1305 The 4th Other ICD Procedure date is missing 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 24  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. web_announcement_Volume 22 Issue 3_20250930.pdf
... QRR) surveys may assist in justifying rate adjustments. Data gathered from provider responses di- rectly contributes to the analysis of current reimbursement rates and may assist in ...
Terms matched: 1  -  Score: 13  -  30 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2022%20Issue%203_20250930.pdf
4. web_announcement_Volume 22 Issue 2_20250707.pdf
... of this new Department have been resoundingly clear since the beginning: unify similarly aligned agen- cies to leverage the purchasing power of Medicaid, lower healthcare costs for ...
Terms matched: 1  -  Score: 14  -  07 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2022%20Issue%202_20250707.pdf
5. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
6. Immunomodulators_2018-0910.pdf
... , patient global disease activity score â ‰ 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ‰ 1 tender enthesis point]) ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-0910.pdf
7. Immunomodulators_2018-09.pdf
... , patient global disease activity score â ‰ 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ‰ 1 tender enthesis point]) ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-09.pdf
8. Immunomodulators_2017-1228.pdf
... , patient global disease activity score â ‰ 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ‰ 1 tender enthesis point]) ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-1228.pdf
9. Immunomodulators_2017-09.pdf
... , patient global disease activity score â ‰ 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ‰ 1 tender enthesis point]) ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-09.pdf
10. Immunomodulators_2017-0615.pdf
... , patient global disease activity score â ‰ 20, HAQ disability index [HAQ DI] â ‰ 0.5, and â ‰ 1 tender enthesis point]) ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-0615.pdf
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