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_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... of fluoride 00 1 unit per 6 months D1351 Sealant - per tooth 1 per 60 months, limited to FULLY erupted permanent 00 pre-molars and 1st and 2nd molars ...
Terms matched: 1  -  Score: 191  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
2. NV_BillingGuidelines_PT22-attachmentB.pdf
... of fluoride 00 1 unit per 6 months D1351 Sealant - per tooth 1 per 60 months, limited to FULLY erupted permanent 00 pre-molars and 1st and 2nd molars ...
Terms matched: 1  -  Score: 191  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
3. NV_EVS_User_Manual_Ch4.pdf
... the panels. 5 4.3. Process Types Create Authorization is a one-page process for ... . Click the Search button again. 30 4.9. Checking PA status through member ...
Terms matched: 2  -  Score: 249  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
4. FA-11B.pdf
... Portal. Questions? Call: (800) 525-2395 DATE OF REQUEST: REQUEST TYPE: Initial Prior Authorization â€" Start date of services: ____ ...
Terms matched: 1  -  Score: 52  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11B.pdf
5. FA-11.pdf
... notify sender immediately and shall destroy all information received. DATE OF REQUEST: REQUEST TYPE: Initial Prior Authorization Concurrent Authorization Unscheduled Revision Retrospective Authorization â€" Date ...
Terms matched: 1  -  Score: 23  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
6. NV_BillingGuidelines_PT33_20250623.pdf
... Provider Type 33 Billing Guide Durable Medical Equipment, Prosthetics, Orthotics and Disposable ... (code B4036) is limited to 30 units per month. To bill a ...
Terms matched: 2  -  Score: 229  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
7. NV_Billing_General.pdf
... providers, regardless of provider type (PT), ... providers upon re-enrollment 01/30/2009 Chapter 3 ... who do not revalidate within 60 days of the date ...
Terms matched: 3  -  Score: 597  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
8. NV_BillingGuidelines_PT33.pdf
... Provider Type 33 Billing Guide Durable Medical Equipment, Prosthetics, Orthotics and Disposable ... (code B4036) is limited to 30 units per month. To bill a ...
Terms matched: 2  -  Score: 229  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
9. Error_Code_to_EOB_to_ANSI.pdf
... , if present. 273 TYPE OF BILL MISSING 4100 ... /08/2025 Page 30 of 229 Claim Error ... EOB/ANSI Code Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE ...
Terms matched: 3  -  Score: 898  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
10. NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... of fluoride 00 1 unit per 6 months D1351 Sealant - per tooth 1 per 60 months, limited to FULLY erupted permanent 00 pre-molars and 1st and 2nd molars ...
Terms matched: 1  -  Score: 191  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
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