Nevada Medicaid and Nevada Check Up News (Second Quarter 2026 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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IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims. See Web Announcement 3983.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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 https://NevadaMedicaid.nv.gov/ and the Billing Guide for your provider type at www.medicaid.nv.gov.

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1. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
2. Known_Issues.pdf
... Nursing Facilities must have at least one payable accommodation revenue code on the claim. 80 Claims, Dental Some dental claims are being denied incorrectly • Provider ...
Terms matched: 1  -  Score: 23  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... Payment Information REF), if present. 319 Diagnosis not allowed for abortion CPTs 80 PROCEDURE CODE NOT PAYABLE WITH 11 The diagnosis is inconsistent with the M64 Missing ...
Terms matched: 1  -  Score: 56  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_EVS_User_Manual_Ch3.pdf
... number, such as days, or a dollar amount. o For value codes 80 â€" Covered Days and 81 â€" Non Covered Days enter ...
Terms matched: 1  -  Score: 26  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
5. NV_BillingGuidelines_PT74.pdf
... postpartum care (Allowed 59510 when assisting physician on cesarean delivery. Bill with modifier 80 or 81) Cesarean only delivery 59514 (Allowed when assisting physician on cesarean ...
Terms matched: 1  -  Score: 34  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74.pdf
6. NV_BillingGuidelines_PT74_20250821.pdf
... postpartum care (Allowed 59510 when assisting physician on cesarean delivery. Bill with modifier 80 or 81) Cesarean only delivery 59514 (Allowed when assisting physician on cesarean ...
Terms matched: 1  -  Score: 34  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74_20250821.pdf
7. NV_Flex_User_Guide_Group.pdf
... Page 17 of 40 pv(09/17/2025) corporation that owns 80 percent of the stock of the disclosing entity, A’s interest ...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
8. NV_Flex_User_Guide_Individual.pdf
... Example: If A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity, A’s interest ...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
9. Benefit_Enrollment_and_Maintenance_(834).pdf
... ICM Member Income 79 2100A ICM01 Member Income Frequency 4 1 4 = Monthly Code 80 2100A ICM02 Member Income Amount 11 characters, including decimal 84 2100A LUI Member ...
Terms matched: 1  -  Score: 29  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
10. NV_BillingGuidelines_PT74_20250804.pdf
... postpartum care (Allowed 59510 when assisting physician on cesarean delivery. Bill with modifier 80 or 81) Cesarean only delivery 59514 (Allowed when assisting physician on cesarean ...
Terms matched: 1  -  Score: 34  -  21 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT74_20250804.pdf
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