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.

EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

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_PT22-attachmentA.pdf
... INCLUDES OBTAINING GRAFT 01 01 01 Service limitation is based on authorization. 88304 LEVEL III, SURGICAL PATHOLOGY, GROSS 00 02 NC Once in a lifetime service limit ...
Terms matched: 1  -  Score: 12  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_EnrollmentCriteria_PT17_Spec188.pdf
... contact information for a point of contact with the EHR vendor for follow-up questions. iii. If extracts to meet State of Nevada requirements have not already been developed ...
Terms matched: 1  -  Score: 35  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
3. NV_BillingGuidelines_PT14_online_030525.pdf
... least 4 hours per QMHP, Services are delivered under the Yes, required Level III and program, less than 24 hours day, up to 5 days per ...
Terms matched: 1  -  Score: 92  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
4. NV_BillingGuidelines_PT14.pdf
... least 4 hours per QMHP, Services are delivered under the Yes, required Level III and program, less than 24 hours day, up to 5 days per ...
Terms matched: 1  -  Score: 88  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
5. NV_Billing_General.pdf
... Center. Updated 01/01/2026 Billing Manual Pv12/15/2025 iii Date (mm/dd/yyyy) Description of changes Pages impacted 10 ...
Terms matched: 1  -  Score: 24  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
6. NV_Billing_General_20251215.pdf
... Center. Updated 12/15/2025 Billing Manual Pv10/17/2025 iii Date (mm/dd/yyyy) Description of changes Pages impacted 10 ...
Terms matched: 1  -  Score: 24  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
7. NV_Billing_General_20251017.pdf
... Center. Updated 10/17/2025 Billing Manual Pv08/01/2025 iii Date (mm/dd/yyyy) Description of changes Pages impacted 10 ...
Terms matched: 1  -  Score: 24  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
8. NV_BillingGuidelines_PT60.pdf
... I & II, maximum of Interns working 6 hours per 90-day period; Level III, maximum of 9 hours per 90-day within their scope period; Level IV ...
Terms matched: 1  -  Score: 54  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
9. NV_BillingGuidelines_PT60_2024-0828.pdf
... I & II, maximum of Interns working 6 hours per 90-day period; Level III, maximum of 9 hours per 90-day within their scope period; Level IV ...
Terms matched: 1  -  Score: 54  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
10. FA-11.pdf
... Code: Disorder: Secondary Code: Disorder: Tertiary Code: Disorder: SECTION III. CURRENT MEDICATION(S ) Current Medications (indicate changes since last report ...
Terms matched: 1  -  Score: 21  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
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