Nevada Medicaid and Nevada Check Up News (First 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]

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for April 2026 Professional Claims. See Web Announcement 3915.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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.

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1. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
2. 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  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
3. NV_BillingGuidelines_PT11.pdf
... Level I / Transitional Care Level II 0172 InterQual II / MCG Level II Level III 0173 InterQual III & IV / MCG Level III & IV Level IV 0174 ...
Terms matched: 1  -  Score: 34  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
4. NV_BillingGuidelines_PT11_online_082725.pdf
... Level I / Transitional Care Level II 0172 InterQual II / MCG Level II Level III 0173 InterQual III & IV / MCG Level III & IV Level IV 0174 ...
Terms matched: 1  -  Score: 34  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
5. 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  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
6. NV_BillingGuidelines_PT60_2025-1216.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  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
7. FA-91.pdf
... Hospice Provider: Date of change in Hospice providers: Reason for change: SECTION III: REVOCATION OF HOSPICE SERVICES I/Legal Representative/Agent for the recipient ...
Terms matched: 1  -  Score: 20  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-91.pdf
8. FA-30.pdf
... facilities contacted, date, contact person and reason for denial (attach) SECTION III: SERVICING PROVIDER INFORMATION Current Provider Name and Unit: Telephone Number: Fax ...
Terms matched: 1  -  Score: 21  -  16 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30.pdf
9. FA-30-I.pdf
... that were contacted when attempting to locate a Nevada facility for this recipient. SECTION III: SERVICING PROVIDER INFORMATION • Current Provider Name and Unit †...
Terms matched: 1  -  Score: 20  -  16 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-30-I.pdf
10. 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  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
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