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. NV_Billing_General.pdf
... FFS) program or the Managed Care Organization (MCO) program. Outside of urban Washoe and urban Clark counties, most recipients are in the FFS program. ...
Terms matched: 1  -  Score: 70  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
2. web_announcement_3753_20251024.pdf
... page. How to Pick a Health Plan & Free Extra Benefits Open enrollment for urban members is from October 1st -December 26th, 2025. Rural members will be ...
Terms matched: 1  -  Score: 148  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
3. NV_Billing_General_20250801.pdf
... FFS) program or the Managed Care Organization (MCO) program. Outside of urban Washoe and urban Clark counties, most recipients are in the FFS program. ...
Terms matched: 1  -  Score: 70  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
4. NV_BillingGuidelines_PT90.pdf
... the service is rendered. Members will automatically be assigned an indicator of Rural or Urban based on the Zip code of their residence. The rates for rural areas ...
Terms matched: 1  -  Score: 21  -  26 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT90.pdf
5. web_announcement_3704_20250826.pdf
... member in a rural area. Members will now be automatically assigned an indicator of Urban or Rural based on the zip code of their residential address. This indicator ...
Terms matched: 1  -  Score: 20  -  26 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3704_20250826.pdf
6. NV_BillingGuidelines_PT17_online_20250804.pdf
... Federally Qualified Health Center (FQHC) 182 Indian Health Service (IHS), Urban Indian Organizations. 183 Comprehensive Outpatient Rehabilitation Facility (CORF) 188 Certified Community ...
Terms matched: 1  -  Score: 68  -  11 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_online_20250804.pdf
7. NV_BillingGuidelines_PT17.pdf
... Federally Qualified Health Center (FQHC) 182 Indian Health Service (IHS), Urban Indian Organizations. 183 Comprehensive Outpatient Rehabilitation Facility (CORF) 188 Certified Community ...
Terms matched: 1  -  Score: 66  -  11 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17.pdf
8. web_announcement_3694_20250811.pdf
... 181 (Federally Qualified Health Centers), and 182 (Indian Health Services, Urban Indian Organizations): Long-Acting Reversible Contraception (LARC) Updates Update to Web ...
Terms matched: 1  -  Score: 23  -  11 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3694_20250811.pdf
9. NV_BillingGuidelines_PT17_online_20250414.pdf
... Federally Qualified Health Center (FQHC) 182 Indian Health Service (IHS), Urban Indian Organizations. 183 Comprehensive Outpatient Rehabilitation Facility (CORF) 188 Certified Community ...
Terms matched: 1  -  Score: 68  -  04 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_online_20250414.pdf
10. NV_Billing_General_20250220.pdf
... FFS) program or the Managed Care Organization (MCO) program. Outside of urban Washoe and urban Clark counties, most recipients are in the FFS program. ...
Terms matched: 1  -  Score: 70  -  29 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250220.pdf
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