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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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.

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1. Known_Issues.pdf
... (Spherocylinder, • Once resolved, claims will be single vision, plus or minus 4.25d to plus or minus automatically reprocessed. 7.00 sphere, 0.12 ...
Terms matched: 1  -  Score: 38  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_Billing_General_20250801.pdf
... eligibility. QMB recipients who are also eligible for full Medicaid benefits have a QMB Plus eligibility status. QMB recipients not eligible for Medicaid benefits have a QMB Only ...
Terms matched: 1  -  Score: 10  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
3. NV_Billing_General.pdf
... eligibility. QMB recipients who are also eligible for full Medicaid benefits have a QMB Plus eligibility status. QMB recipients not eligible for Medicaid benefits have a QMB Only ...
Terms matched: 1  -  Score: 10  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
4. NV_EVS_User_Manual_Ch3.pdf
... that panel. 5 Click Expand All to expand all panels, or click the plus icons on each panel to open only that panel. Diagnosis Codes The first ...
Terms matched: 1  -  Score: 102  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
5. NV_EVS_User_Manual_Ch8.pdf
... below: â – ª 10-digit Provider NPI/API example 0000000000 â – ª Plus 11-digit Recipient Medicaid ID example 11111100000 â – ª Plus 6- or 8-digit ...
Terms matched: 1  -  Score: 50  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch8.pdf
6. web_announcement_3727_20250918.pdf
... , Clarifications and Updates 57599-0835-00 Continuous Glucose FREESTYLE LIBRE 2 Added to Preferred List Monitors PLUS SENSOR 08508-3000-88 Insulin Delivery System OMNIPOD 5 G6/LIBRE 2 Added to Preferred ...
Terms matched: 1  -  Score: 82  -  18 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3727_20250918.pdf
7. web_announcement_3726_20250918.pdf
... ACCU-CHEK SMARTVIEW 65702-0492-10 Blood Glucose Strips Added to Preferred List TEST STRIP 65702-0493-10 ACCU-CHEK AVIVA PLUS 65702-0407-10 Blood Glucose Strips Added to Preferred List TEST STRIP 65702-0408-10 Traditional Blood Glucose ...
Terms matched: 1  -  Score: 20  -  18 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3726_20250918.pdf
8. NV_Billing_General_20250220.pdf
... eligibility. QMB recipients who are also eligible for full Medicaid benefits have a QMB Plus eligibility status. QMB recipients not eligible for Medicaid benefits have a QMB Only ...
Terms matched: 1  -  Score: 10  -  29 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250220.pdf
9. NV_BillingGuidelines_PT33_20240523.pdf
... MSRP; b) if there is no MSRP, reimbursement will be acquisition cost plus 20%, verifiable with manufacturer’s invoice; or c) ...
Terms matched: 1  -  Score: 16  -  23 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20240523.pdf
10. NV_BillingGuidelines_PT33.pdf
... MSRP; b) if there is no MSRP, reimbursement will be acquisition cost plus 20%, verifiable with manufacturer’s invoice; or c) ...
Terms matched: 1  -  Score: 16  -  23 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
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