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 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. Error_Code_to_EOB_to_ANSI.pdf
... Information REF), if present. 227 THIRD PARTY PAYMENT AMOUNT 81 Primary Carrier Pay missing or invalid. 16 Claim/service lacks information or has N58 Missing ...
Terms matched: 1  -  Score: 176  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Known_Issues.pdf
... Legislature SB 504 & 439 rate parity were not automatically reprocessed. Provider reprocessed to pay the correct rate in the reprocessing Types 24 and effort on 01/08 ...
Terms matched: 1  -  Score: 78  -  07 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_BillingGuidelines_PT17_Spec181.pdf
... and customary amounts for each code. Note: codes billed at lesser amounts will pay at the lesser amount. Modifier 25 must be included on the medical encounter ...
Terms matched: 1  -  Score: 20  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
4. NV_Billing_General_20251017.pdf
... recipient whenâ€.... 29 Incorrect TPL information.... 29 Discovering TPL after Medicaid pays .... 29 Chapter 6: Electronic data interchange .... 30 EDI defined... ...
Terms matched: 1  -  Score: 98  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
5. NV_Billing_General_20251215.pdf
... whenâ€.... 29 Incorrect TPL information .... 29 Discovering TPL after Medicaid pays .... 29 Chapter 6: Electronic data interchange .... 30 EDI defined... ...
Terms matched: 1  -  Score: 98  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
6. NV_Billing_General.pdf
... whenâ€.... 29 Incorrect TPL information .... 29 Discovering TPL after Medicaid pays .... 29 Chapter 6: Electronic data interchange .... 30 EDI defined... ...
Terms matched: 1  -  Score: 98  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_BillingGuidelines_PT60_2024-0828.pdf
... provided as part of an IEP may be billed with the modifier TM. Medicaid pays the claim and then attempts to recover the paid amount from the legally responsible ...
Terms matched: 1  -  Score: 14  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
8. NV_BillingGuidelines_PT60.pdf
... provided as part of an IEP may be billed with the modifier TM. Medicaid pays the claim and then attempts to recover the paid amount from the legally responsible ...
Terms matched: 1  -  Score: 14  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
9. NV_Flex_User_Guide_Group.pdf
... address for an organization requires a separate application. Paper checks will be mailed to Pay To address while Electronic Funds Transfer (EFT) testing is performed. If ...
Terms matched: 1  -  Score: 36  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
10. NV_Flex_User_Guide_Individual.pdf
... 38 pv(09/17/2025) Paper checks will be mailed to Pay To address while Electronic Funds Transfer (EFT) testing is performed. If ...
Terms matched: 1  -  Score: 34  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
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