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 September 2026 Professional Claims. See Web Announcement 4031.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 4053.

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. Error_Code_to_EOB_to_ANSI.pdf
... Payment Information REF), if present. 376 4TH OTHER ICD PROCEDURE DATE MISSING 1305 The 4th Other ICD Procedure date is missing or 16 Claim/service lacks ...
Terms matched: 1  -  Score: 24  -  12 Nov 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. 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
3. 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
4. web_announcement_2843_20220714.pdf
... JCM.00168-08. Epub 2008 Jul 9 4. Abedi GR, Watson JT, Nix WA, Oberste SM, Gerber SI. Enterovirus and Parechovirus Surveillance â€" ...
Terms matched: 1  -  Score: 20  -  15 Jul 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2843_20220714.pdf
5. web_announcement_2771_20220429.pdf
... Modifier KX or Condition Code 45 for Claims for Transgender Individuals Reminder to Web Announcement 1305: Providers submitting claims for sex-specific services are reminded to use modifier KX ( ...
Terms matched: 1  -  Score: 23  -  29 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2771_20220429.pdf
6. FFS_DUR_Binder_April_2022.pdf
... MEDICINE 2 4 120 740 33,300 278 139 2021 Q4 Pres 34 PUYALLUP WA Student- Organized Health Program 1 1 30 90 4,050 135 135 ...
Terms matched: 1  -  Score: 10  -  20 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_April_2022.pdf
7. FFS_DUR Binder_April_2022.pdf
... MEDICINE 2 4 120 740 33,300 278 139 2021 Q4 Pres 34 PUYALLUP WA Student- Organized Health Program 1 1 30 90 4,050 135 135 ...
Terms matched: 1  -  Score: 10  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR%20Binder_April_2022.pdf
8. E-Binder_SSSB_March_2022.pdf
... are indicated for the temporary relief of itchy eyes due to pollen, ragweed, grass, animal hair, and dander. â — ‹ The ophthalmic mast cell ...
Terms matched: 1  -  Score: 21  -  22 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_March_2022.pdf
9. Ophthalmic_Anti-Allergy_2022-03.pdf
... are indicated for the temporary relief of itchy eyes due to pollen, ragweed, grass, animal hair, and dander. â — ‹ The ophthalmic mast cell ...
Terms matched: 1  -  Score: 35  -  09 Feb 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Ophthalmic_Anti-Allergy_2022-03.pdf
10. FFS_DUR_Binder_January_2022.pdf
... Allergan; March 2021. • Vyepti [dossier], Bothell, WA: Lundbeck Pharmaceuticals; March 2020. • Vyepti [package insert ...
Terms matched: 1  -  Score: 24  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_January_2022.pdf
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