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_03-23-26.pdf
... 00 = Prior authorization is not required for EPSDT/Healthy Kids and for adult emergency services. 01 = Prior authorization is required. 02 = Prior authorization is ...
Terms matched: 1  -  Score: 31  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
2. NV_BillingGuidelines_PT22-attachmentA.pdf
... : 00 = Prior authorization is not required for EPSDT/Healthy Kids, adult emergency and palliative services, for a pregnancy related service, and expanded adult services ...
Terms matched: 1  -  Score: 31  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
3. NV_BillingGuidelines_PT22.pdf
... Medicaid-eligible adults age 21 and older, not subject to the expenditure limits, include emergency, dentures and palliative care. There is no adult benefit coverage for endodontics ...
Terms matched: 1  -  Score: 16  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
4. NV_BillingGuidelines_PT22_20230327.pdf
... 22 Billing Guide Dentist Dental Services Program Overview Recipients age 21 and older may receive emergency extractions, palliative care, and dentures/prosthetic care under certain guidelines and ...
Terms matched: 1  -  Score: 16  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20230327.pdf
5. NV_BillingGuidelines_PT60_2026-0429.pdf
... school. The aim of this service is to stabilize the individual during a psychiatric emergency. Updated 04/29/2026+ = Add-on code Provider Type 60 ...
Terms matched: 1  -  Score: 38  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
6. NV_BillingGuidelines_PT60.pdf
... school. The aim of this service is to stabilize the individual during a psychiatric emergency. Updated 05/19/2026+ = Add-on code Provider Type 60 ...
Terms matched: 1  -  Score: 38  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. Pregnancy_Presumptive_Eligibility_Instructions.pdf
... PT 28 â€" Pharmacy • PT 96 â€" Rural Emergency Hospital Encounter-based providers may provide and receive reimbursement for the services below using their ...
Terms matched: 1  -  Score: 21  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Instructions.pdf
8. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
9. Known_Issues.pdf
... Form Required reprocessed. â€" header) . 123 Claims, Provider Ground Emergency Medical Transportation • Ground transportation claims submitted by 01/28/ ...
Terms matched: 1  -  Score: 21  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
10. Error_Code_to_EOB_to_ANSI.pdf
... Identification Segment (loop 2110 Service Payment Information REF), if present. 362 EMERGENCY DIAGNOSIS CODE IS 362 Emergency diagnosis code is invalid. 146 Diagnosis was invalid ...
Terms matched: 1  -  Score: 120  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
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