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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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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1. Error_Code_to_EOB_to_ANSI.pdf
... on the claim for the referring provider can be checked in the Additional Claim Information Panel, there should be a row with an Entity Type of DN and an ...
Terms matched: 1  -  Score: 547  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Known_Issues.pdf
... /or Change/Update Change/Update on the “Request Informationâ€panel that they Application with a letter attached Applications cannot proceed to complete their application ...
Terms matched: 1  -  Score: 12  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_Billing_General_20251215.pdf
... field. All MCO coverage details can be found in the Managed Care Assignment Details panel. Updated 12/15/2025 Billing Manual Pv10/17/2025 ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
4. NV_Billing_General.pdf
... field. All MCO coverage details can be found in the Managed Care Assignment Details panel. Updated 01/01/2026 Billing Manual Pv12/15/2025 ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
5. NV_Billing_General_20251017.pdf
... field. All MCO coverage details can be found in the Managed Care Assignment Details panel. Updated 10/17/2025 Billing Manual Pv08/01/2025 ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
6. web_announcement_3803_20251229.pdf
... approvals. • A new BCCP Level of Care (LOC) Tier panel has been added to the recipient profile in MMIS. Note: this enhancement ...
Terms matched: 1  -  Score: 44  -  29 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3803_20251229.pdf
7. NV_EVS_User_Manual_Ch4.pdf
... required fields. 4 When the Create Authorization is first displayed, all of the panels are expanded. Collapse: Click on the (â €" ) button ...
Terms matched: 1  -  Score: 91  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
8. Consent_to_Electronic_Delivery_of_1099.pdf
... on electronic 1099 delivery within the Provider Flex Terms of Agreement section on the Agreement panel by checking the appropriate checkbox. 2. If you do not consent to ...
Terms matched: 1  -  Score: 64  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Consent_to_Electronic_Delivery_of_1099.pdf
9. NV_BillingGuidelines_PT43.pdf
... a provider performs all of the constituent procedures of a covered organ or disease oriented panel, the provider must submit a claim for the panel rather than for each ...
Terms matched: 1  -  Score: 80  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
10. NV_BillingGuidelines_PT43_20250804.pdf
... a provider performs all of the constituent procedures of a covered organ or disease oriented panel, the provider must submit a claim for the panel rather than for each ...
Terms matched: 1  -  Score: 80  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
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