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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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 4 p.m. Pacific Time on Sunday, October 11, 2026, through 3 a.m. Pacific Time on Monday, October 12, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • Provider Flex
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

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 August 2026 Professional Claims. See Web Announcement 4009.

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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During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

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1. NV_Billing_General.pdf
... regulations set forth in the Medicaid Services Manual (MSM) (see MSM Chapter 100 Medicaid Program and MSM Chapter 3300 Program Integrity) • Obtaining prior ...
Terms matched: 1  -  Score: 98  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
2. NV_Billing_General_20260710.pdf
... regulations set forth in the Medicaid Services Manual (MSM) (see MSM Chapter 100 Medicaid Program and MSM Chapter 3300 Program Integrity) • Obtaining prior ...
Terms matched: 1  -  Score: 98  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... : 10/06/2026 Page 100 of 162 Claim Error/EOB/ ... Information REF), if present. 240 DETAIL TDOS DATE IS INVALID 1261 Detail ...
Terms matched: 2  -  Score: 39  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. web_announcement_4025_20261006.pdf
... claims, including those denied upon reprocessing. Please refer to Medicaid Services Manual Chapter 100 and the Billing Manual for information concerning the claim appeal process and time frames ...
Terms matched: 1  -  Score: 20  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4025_20261006.pdf
5. web_announcement_3970_20260722.pdf
... , all private PRTFs will receive a flat rate of $800 for revenue codes 100 and 183. In addition to the new flat rate, a new special ...
Terms matched: 1  -  Score: 59  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3970_20260722.pdf
6. NV_Billing_Sterilization.pdf
... the criteria of medical necessity as outlined in Medicaid Services Manual (MSM) Chapter 100, Section 103.1. Prior Authorization must be requested using form prior to services ...
Terms matched: 1  -  Score: 12  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Sterilization.pdf
7. NV_BillingGuidelines_PT93_Spec704.pdf
... 4100 â€" Substance Use Treatment Services and Coverage • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types ...
Terms matched: 1  -  Score: 26  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec704.pdf
8. NV_BillingGuidelines_PT93_Spec704_online_073126.pdf
... 4100 â€" Substance Use Treatment Services and Coverage • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types ...
Terms matched: 1  -  Score: 26  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec704_online_073126.pdf
9. NV_BillingGuidelines_PT93_Spec707_online_073126.pdf
... 4100 â€" Substance Use Treatment Services and Coverage • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types ...
Terms matched: 1  -  Score: 16  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec707_online_073126.pdf
10. NV_BillingGuidelines_PT93_Spec708.pdf
... 4100 â€" Substance Use Treatment Services and Coverage • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types ...
Terms matched: 1  -  Score: 16  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec708.pdf
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