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 September 2026 Professional Claims. See Web Announcement 4031.

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. FA-11E.pdf
... ) . The requested services are based upon either a focused or comprehensive service delivery model. Provider is to indicate which delivery model is being utilized. If additional ...
Terms matched: 1  -  Score: 37  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
2. NV_BillingGuidelines_PT85.pdf
... Type 85 Billing Guide Applied Behavior Analysis (ABA) Limits for Authorizations Focused Delivery Model: 15-25 hours per week for all ABA services. Focused ABA is treatment ...
Terms matched: 1  -  Score: 38  -  13 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85.pdf
3. NV_BillingGuidelines_PT85_20260727.pdf
... Type 85 Billing Guide Applied Behavior Analysis (ABA) Limits for Authorizations Focused Delivery Model: 15-25 hours per week for all ABA services. Focused ABA is treatment ...
Terms matched: 1  -  Score: 38  -  13 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_20260727.pdf
4. NV_Billing_General_20260710.pdf
... Evaluation • New requests for PDN Services Behavioral Health and Substance Abuse Agency Model (SAAM) Authorization Requests Provider Types 14, 82 and 17 (specialty ...
Terms matched: 1  -  Score: 11  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
5. NV_Billing_General.pdf
... Evaluation • New requests for PDN Services Behavioral Health and Substance Abuse Agency Model (SAAM) Authorization Requests Provider Types 14, 82 and 17 (specialty ...
Terms matched: 1  -  Score: 11  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
6. web_announcement_4024_20261002.pdf
... changed. Nevada Medicaid is actively working toward development and deployment of this new reimbursement model in alignment with our ongoing commitment to enhance and improve maternity care and support ...
Terms matched: 1  -  Score: 36  -  02 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4024_20261002.pdf
7. NV_BillingGuidelines_PT14.pdf
... . Only enrolled provider type 14 BHCN services. groups with an approved Day Treatment Model and additional enrollment as Specialty 308 can request prior authorization for Day Treatment to ...
Terms matched: 1  -  Score: 29  -  29 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
8. NV_BillingGuidelines_PT14_online_092126.pdf
... . Only enrolled provider type 14 BHCN services. groups with an approved Day Treatment Model and additional enrollment as Specialty 308 can request prior authorization for Day Treatment to ...
Terms matched: 1  -  Score: 29  -  29 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_092126.pdf
9. NV_EnrollmentChecklist_PT14_Day_Treatment_Model_Flex.pdf
... Enrollment Checklist Provider Type 14: Behavioral Health Outpatient Treatment Specialty 308: Day Treatment Model Please refer to the Provider Enrollment Information Booklet for enrollment guidance and to the ...
Terms matched: 1  -  Score: 209  -  21 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Day_Treatment_Model_Flex.pdf
10. NV_EnrollmentChecklist_PT14_Spec309.pdf
... . BHTC services will only be reimbursable for PT 14 groups which have a BHTC model approved by Nevada Medicaid. Providers who do not have an approved model will ...
Terms matched: 1  -  Score: 72  -  21 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Spec309.pdf
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