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. NV_BillingGuidelines_PT34_2023-1121.pdf
... an aerosol generator, nebulizer, metered dose inhaler or IPPB device 94667 Manipulation chest wall, such as cupping, percussing, Required and vibration to facilitate lung function ...
Terms matched: 1  -  Score: 24  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
2. NV_BillingGuidelines_PT34.pdf
... an aerosol generator, nebulizer, metered dose inhaler or IPPB device 94667 Manipulation chest wall, such as cupping, percussing, Required and vibration to facilitate lung function ...
Terms matched: 1  -  Score: 24  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
3. FA-16B.pdf
... PT = Physical Therapy ï Oxygen via trach continuously HFCWO Vest = High Frequency Chest Wall Oscillation Vest ï Oxygen via vent continuously ï No Chest PT, HFCWO Vest ...
Terms matched: 1  -  Score: 12  -  20 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-16B.pdf
4. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
5. Incretin_Mimetics_2014_0811.pdf
... containing lyophilized powder for reconstitution (each unit contains one 29-gauge, 5-mm, thin wall needle) . †Supplied in cartons of four single-dose trays (one ...
Terms matched: 1  -  Score: 28  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Incretin_Mimetics_2014_0811.pdf
6. Incretin mimetics 2014 11.pdf
... containing lyophilized powder for reconstitution (each unit contains one 29-gauge, 5-mm, thin wall needle) . †Supplied in cartons of four single-dose trays (one ...
Terms matched: 1  -  Score: 28  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Incretin%20mimetics%202014%2011.pdf
7. HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
... JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, ... QD plus warfarin with early carotid 12 walls of the 0.006 mm/year, ...
Terms matched: 2  -  Score: 47  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
8. HMG CoA Reductase Inhibitors.pdf
... JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, ... QD plus warfarin with early carotid 12 walls of the 0.006 mm/year, ...
Terms matched: 2  -  Score: 47  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG%20CoA%20Reductase%20Inhibitors.pdf
9. Growth_Hormone_2013-0812.pdf
... 3 left ventricular minutes at low fractional speed on a shortening, LVM horizontal and wall treadmill thickness parameters and echocardio- graphic indices of diastolic function 92 Snyder et ...
Terms matched: 1  -  Score: 22  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Growth_Hormone_2013-0812.pdf
10. Growth Hormone.pdf
... 3 left ventricular minutes at low fractional speed on a shortening, LVM horizontal and wall treadmill thickness parameters and echocardio- graphic indices of diastolic Page 60 of 124 ...
Terms matched: 1  -  Score: 22  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Growth%20Hormone.pdf
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