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]

Notifications

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

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 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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... not an ALERT) . 3382 ABORTION CERTIFICATE REQUIRED - DTL 346 Life of the mother is not indicated as being 96 Non-covered charge(s ) . At least ...
Terms matched: 1  -  Score: 11  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... Nevada Check Up recipients in urban Clark and urban Washoe counties are enrolled If a mother is enrolled in an MCO, is in an MCO beginning on their first ...
Terms matched: 1  -  Score: 11  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
... Nevada Check Up recipients in urban Clark and urban Washoe counties are enrolled If a mother is enrolled in an MCO, is in an MCO beginning on their first ...
Terms matched: 1  -  Score: 11  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... iso-immunization, parvovirus infection) artery • Poor fetal growth affecting management of mother Updated 08/04/2025 Provider Type 20, 24 and 77 Billing ...
Terms matched: 1  -  Score: 24  -  13 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_080425_to_101325.pdf
... unspecified O35.3XX0 Maternal care for (suspected) damage to fetus from viral disease in mother, not applicable or unspecified O35.4XX0 Maternal care for (suspected) damage to ...
Terms matched: 1  -  Score: 12  -  02 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_Emergency_Diagnosis_Codelist.pdf
... & Supplies Breast pumps and supplies are covered in an Outpatient Hospital setting for Nursing Mothers with infants up to 12 months of age. The hospital is able to ...
Terms matched: 1  -  Score: 20  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20250804.pdf
... two claims for maternity services: one for the newborn and a second for the mother. On claims for services provided to newborns, use the newborn’ ...
Terms matched: 1  -  Score: 12  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
... & Supplies Breast pumps and supplies are covered in an Outpatient Hospital setting for Nursing Mothers with infants up to 12 months of age. The hospital is able to ...
Terms matched: 1  -  Score: 12  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12.pdf
... two claims for maternity services: one for the newborn and a second for the mother. On claims for services provided to newborns, use the newborn’ ...
Terms matched: 1  -  Score: 12  -  27 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_050625.pdf
... iso-immunization, parvovirus infection) artery • Poor fetal growth affecting management of mother 76825 Echocardiography Fetal Once per pregnancy for: • A potential defect ...
Terms matched: 1  -  Score: 26  -  21 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74.pdf
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