Nevada Medicaid and Nevada Check Up News (Fourth 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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EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 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_PT14_online_030525.pdf
... a No All Levels the evaluation and management of a are spent face-to- other detailed history; a detailed examination; new patient face with the patient qualified and ...
Terms matched: 1  -  Score: 58  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
2. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... (EMO) coverage. Refer to the Emergency Medicaid Only Billing Instructions for additional details on coverage. Delivering Provider Labor and delivery services include home delivery, admission ...
Terms matched: 1  -  Score: 26  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
3. NV_BillingGuidelines_PT14.pdf
... a No All Levels the evaluation and management of a are spent face-to- other detailed history; a detailed examination; new patient face with the patient qualified and ...
Terms matched: 1  -  Score: 54  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
4. NV_BillingGuidelines_PT20-24-77.pdf
... (EMO) coverage. Refer to the Emergency Medicaid Only Billing Instructions for additional details on coverage. Delivering Provider Updated 01/12/2026 Provider Type 20 ...
Terms matched: 1  -  Score: 26  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
5. Error_Code_to_EOB_to_ANSI.pdf
... M76 Missing/incomplete/invalid diagnosis or INVALID service reported. condition. 226 DETAIL UNITS BILLED GREATER THAN 226 DETAIL NUMBER OF UNITS BILLED IS 16 Claim/ ...
Terms matched: 1  -  Score: 496  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. Known_Issues.pdf
... claim will show edit 5006-(Possible Duplicate of a Previously Paid Claim/Detail) on the Web Portal. 5 Claims, XOVOT Crossover only claims are ...
Terms matched: 1  -  Score: 270  -  07 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
7. NV_BillingGuidelines_PT17_Spec181.pdf
... This concept is referred to as the WRAP Supplemental Payment Program, additional information is detailed below. Policy Please see the appropriate MSM Chapters for covered and non-covered Medicaid ...
Terms matched: 1  -  Score: 23  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
8. NV_Billing_General_20251215.pdf
... see the list of options available under each item. See Web Announcement 1204 for details regarding the features on the website. Web Announcements The five most recent web ...
Terms matched: 1  -  Score: 92  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
9. NV_Billing_General.pdf
... see the list of options available under each item. See Web Announcement 1204 for details regarding the features on the website. Web Announcements The five most recent web ...
Terms matched: 1  -  Score: 88  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
10. NV_Billing_General_20251017.pdf
... see the list of options available under each item. See Web Announcement 1204 for details regarding the features on the website. Web Announcements The five most recent web ...
Terms matched: 1  -  Score: 88  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
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