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. NV_BillingGuidelines_PT22-attachmentA.pdf
... recipient, any provider. D7241 and D7261 are contraindicated against each other - within 90 days, same recipient, any provider. D7250 TOOTH ROOT REMOVAL 00 00 ...
Terms matched: 1  -  Score: 24  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
... recipient, any provider. D7241 and D7261 are contraindicated against each other - within 90 days, same recipient, any provider. D7250 TOOTH ROOT REMOVAL 00 00 ...
Terms matched: 1  -  Score: 24  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
3. NV_BillingGuidelines_PT22_20230327.pdf
... dates and you provided services within those dates. You must request retrospective authorization within 90 days of the date of the eligibility decision. (This does not apply ...
Terms matched: 1  -  Score: 12  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20230327.pdf
4. NV_BillingGuidelines_PT22.pdf
... dates and you provided services within those dates. You must request retrospective authorization within 90 days of the date of the eligibility decision. (This does not apply ...
Terms matched: 1  -  Score: 12  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
5. NV_BillingGuidelines_PT34_2026-0101.pdf
... 15 sessions (6 units per session) for a units of codes total of 90 units to be completed in approximately 3 97140, 97110 weeks. and/ ...
Terms matched: 1  -  Score: 28  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2026-0101.pdf
6. NV_BillingGuidelines_PT34.pdf
... 15 sessions (6 units per session) for a units of codes total of 90 units to be completed in approximately 3 97140, 97110 weeks. and/ ...
Terms matched: 1  -  Score: 26  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
7. NV_BillingGuidelines_PT60.pdf
... Medicaid Mental Health Services. After the initial screening, student must be re-screened every 90 calendar days to reevaluate their intensity of needs (Level of Care) . ...
Terms matched: 1  -  Score: 50  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
8. NV_BillingGuidelines_PT60_2026-0429.pdf
... Medicaid Mental Health Services. After the initial screening, student must be re-screened every 90 calendar days to reevaluate their intensity of needs (Level of Care) . ...
Terms matched: 1  -  Score: 50  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
9. NV_BillingGuidelines_PT97.pdf
... the existing authorization period. Retrospective Request for Retro-eligible Recipients: Submit no later than 90 calendar days from the date the recipient was determined eligible for Medicaid benefits. ...
Terms matched: 1  -  Score: 21  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT97.pdf
10. NV_BillingGuidelines_PT97_2025-1001.pdf
... the existing authorization period. Retrospective Request for Retro-eligible Recipients: Submit no later than 90 calendar days from the date the recipient was determined eligible for Medicaid benefits. ...
Terms matched: 1  -  Score: 21  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT97_2025-1001.pdf
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