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]

Notifications

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 4053.

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.

Scheduled Site Maintenance

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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... reference documents for Medicaid billing. Authority This manual does not have the effect of law or regulation. Every effort has been made to ensure accuracy, however, ...
Terms matched: 1  -  Score: 65  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... reference documents for Medicaid billing. Authority This manual does not have the effect of law or regulation. Every effort has been made to ensure accuracy, however, ...
Terms matched: 1  -  Score: 65  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
... prescriber will enroll. How will Nevada Medicaid accommodate out-of-state prescriptions or orders? Federal law requires all OPR physicians or other professionals rendering services under the State Plan to ...
Terms matched: 1  -  Score: 20  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/OPR_FAQs.pdf
... : CERTIFICATION STATEMENTS A physician acting within the scope of practice as defined by State law certifies the following per 42 CFR 441.152: 1. Ambulatory care resources available ...
Terms matched: 1  -  Score: 20  -  14 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-12.pdf
... reference documents for Medicaid billing. Authority This manual does not have the effect of law or regulation. Every effort has been made to ensure accuracy, however, ...
Terms matched: 1  -  Score: 65  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
... : CERTIFICATION STATEMENTS A physician acting within the scope of practice as defined by State law certifies the following per 42 CFR 441.152: 1. Ambulatory care resources available ...
Terms matched: 1  -  Score: 20  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-15.pdf
... a service that does not require prior authorization in FFS, unless otherwise required by law. • Further, it does not prohibit an MCO from approving ...
Terms matched: 1  -  Score: 58  -  29 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4020_20260929.pdf
... Families Tax Cut (WFTC) legislation, or HR1, which was signed into law in July 2025. Many adults, ages 19-64, will need to meet ...
Terms matched: 1  -  Score: 23  -  29 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4019_20260929.pdf
... . Miscellaneous This agreement shall be interpreted consistently with all applicable federal and state privacy laws. In the event of a conflict between applicable laws, the more stringent ...
Terms matched: 1  -  Score: 103  -  17 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Trading_Partner_Agreement.pdf
... who are eligible for federally funded Medicaid. Beginning October 1, 2026, federal law changes who may qualify for Hospital Presumptive Eligibility (PE) and Pregnancy PE ...
Terms matched: 1  -  Score: 110  -  16 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4005_20260916.pdf
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