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]

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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.

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1. web_announcement_3765_20251112.pdf
... ¢ Procedure codes A4420 (Ostomy Pouch, Closed; for use on Barrier with Locking Flange) and A4483 (Moisture Exchanger) no longer require initial prior authorization ...
Terms matched: 1  -  Score: 21  -  12 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3765_20251112.pdf
2. NV_Flex_User_Guide_Individual.pdf
... , select “Lock Answers & Proceedâ€. Once these answers have been locked, this information cannot be changed. The current application will need to be ...
Terms matched: 1  -  Score: 14  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
3. NV_Flex_User_Guide_Group.pdf
... needed, select “Lock Answers & Proceed.â€Once these answers have been locked, this information cannot be changed. The current application will need to be ...
Terms matched: 1  -  Score: 14  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
4. ICD-10_Emergency_Diagnosis_Codelist.pdf
... maternal pelvic organs O66.0 Obstructed labor due to shoulder dystocia O66.1 Obstructed labor due to locked twins O66.40 Failed trial of labor, unspecified O66.5 Attempted application of vacuum extractor ...
Terms matched: 1  -  Score: 12  -  02 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_Emergency_Diagnosis_Codelist.pdf
5. ICD-10_Cesarean_Section_Diagnosis_Codes.pdf
... disproportion, unspecified O66.0 Obstructed labor due to shoulder dystocia O66.1 Obstructed labor due to locked twins O66.40 Failed trial of labor, unspecified O66.5 Attempted application of vacuum extractor ...
Terms matched: 1  -  Score: 12  -  02 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_Cesarean_Section_Diagnosis_Codes.pdf
6. NV_Flex_User_Guide_Getting_Started.pdf
... an error message will display. After three failed attempts, the account will be locked for 20 minutes. Updated 09/02/2025 Page 18 of 34 ...
Terms matched: 1  -  Score: 20  -  02 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
7. FA-30.pdf
... Wandering Behavior Violent Behavior Danger to Self Danger to Others Other Inappropriate Behaviors Requires a Locked Facility No Appropriate Beds Available In-State Requires Specialty Care (Bariatric, Pediatric, ...
Terms matched: 1  -  Score: 23  -  16 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30.pdf
8. FA-19.pdf
... , NG) Glucose Monitoring Insulin Coverage IV O2 Ostomy Pediatric Specialty Care PICC Saline Lock Secured Alzheimer Unit Specialty Bed Suctioning Trach Ventilator Dependent Wound Care DME Other ( ...
Terms matched: 1  -  Score: 21  -  16 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-19.pdf
9. NV_EnrollmentChecklist_PT63_Flex.pdf
... PRTF services at this facility provided in a secure, self-contained environment that can be locked if needed? Yes No Is this PRTF providing 24-hour inpatient care with observation ...
Terms matched: 1  -  Score: 20  -  08 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT63_Flex.pdf
10. NV_EnrollmentChecklist_PT63.pdf
... PRTF services at this facility provided in a secure, self-contained environment that can be locked if needed? Yes No Is this PRTF providing 24-hour inpatient care with observation ...
Terms matched: 1  -  Score: 14  -  20 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT63.pdf
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