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]

Notifications

EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com

Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

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.

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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... D7241 and D7261 are with unusual surgical complications 00 contraindicated against each other - within 90 days, same recipient, any provider. D7250 Removal of residual tooth roots ...
Terms matched: 1  -  Score: 24  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
... recipient, any provider. D7241 and D7261 are contraindicated against each other - within 90 days, same recipient, any provider. D7250 TOOTH ROOT REMOVAL 00 00 ...
Terms matched: 1  -  Score: 24  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
... allowed per lifetime) when the service is rendered for the same tooth numbers. 90 Claims Some claims submitted between 6/7 /19 and • ...
Terms matched: 1  -  Score: 11  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... Worker Doula Services Specialty type codes: 90 • 890: Doula ( ... (EVV Required) • 200: Environmental Accessibility Adaptations • ...
Terms matched: 2  -  Score: 126  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... €¢ Retrospective request (for recipient retroactive eligibility): Submit no later than 90 calendar days from the recipient’s Date of Decision (i.e. ...
Terms matched: 1  -  Score: 137  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
... the existing authorization period. • Retrospective request: Submit no later than 90 days from the recipient’s Date of Decision (i.e., ...
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... purchase) â€" 1 unit per 3 yrs A4287 Disposable collection and storage 200 units per 30 rolling days bag for breast milk Prior authorization for breast pumps ...
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... €¢ Retrospective request (for recipient retroactive eligibility): Submit no later than 90 calendar days from the recipient’s Date of Decision (i.e. ...
Terms matched: 1  -  Score: 131  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
... A, Policy #6-06. A 90- day global period applies to implantation ... 3 yrs A4287 Disposable collection and storage 200 units per 30 rolling days bag for ...
Terms matched: 2  -  Score: 23  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
... the existing authorization period. • Retrospective request: Submit no later than 90 days from the recipient’s Date of Decision (i.e., ...
Terms matched: 1  -  Score: 20  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26.pdf
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