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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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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. Known_Issues.pdf
... 74-(Nurse Midwife) for needed. Professional procedure codes that were updated per the 82nd • Once resolved, claims will be Crossover, Legislature ...
Terms matched: 1  -  Score: 353  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EVS_User_Manual_Ch3.pdf
... €¢ Repeat for additional attachments if needed up to 10 attachments can be added per claim (Note: the combined size of all attachments cannot exceed 4MB) ...
Terms matched: 1  -  Score: 50  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
3. NV_BillingGuidelines_PT14.pdf
... pregnant women only. The limitation for both codes is a maximum of 24 encounters per year. These limitations can be exceeded if determined medically necessary by Nevada Medicaid ...
Terms matched: 1  -  Score: 410  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
4. NV_BillingGuidelines_PT14_online_011226.pdf
... pregnant women only. The limitation for both codes is a maximum of 24 encounters per year. These limitations can be exceeded if determined medically necessary by Nevada Medicaid ...
Terms matched: 1  -  Score: 410  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
5. NV_BillingGuidelines_PT26_20260112.pdf
... Procedural Terminology (CPT) code 90791 (psychiatric diagnostic evaluation) is covered twice per calendar year for each episode of care. Additional services require prior authorization. ...
Terms matched: 1  -  Score: 164  -  13 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20260112.pdf
6. NV_BillingGuidelines_PT26.pdf
... pregnant women only. The limitation for both codes is a maximum of 24 encounters per year. These limitations can be exceeded if determined medically necessary by Nevada Medicaid ...
Terms matched: 1  -  Score: 131  -  13 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... of the following are true, post PLAN Managed Care Plan. The service requested per coordination of benefits. the edit at the header: 1) The member's ...
Terms matched: 1  -  Score: 493  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. Provider_Enrollment_Information_Booklet.pdf
... Services (EVV Required) • 202: Personal Emergency Response System (PERS) • 208: Adult Companion Service (EVV Required) â ...
Terms matched: 1  -  Score: 175  -  09 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
9. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... (D0120-D1354) D0120 Periodic oral examination - Patient of Record 00 1 service unit per 6 rolling months D0150 Comprehensive oral examination - New Patient 00 1 service unit ...
Terms matched: 1  -  Score: 547  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
10. NV_BillingGuidelines_PT22-attachmentB.pdf
... (D0120-D1354) D0120 Periodic oral examination - Patient of Record 00 1 service unit per 6 rolling months D0150 Comprehensive oral examination - New Patient 00 1 service unit ...
Terms matched: 1  -  Score: 547  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
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