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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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 2026, for scheduled maintenance:
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  • Gabby®, which includes:
    • Gainwell Technologies Contact Center (877) 638-3472
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    • Known System Issues-Click HERE

    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    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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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
... impacted tooth-completely bony), D7210-(extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap) ...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_BillingGuidelines_PT60_2025-1216.pdf
... units per 60 months three contiguous teeth or tooth bounded spaces per quadrant. D4263 Bone replacement graft â€" retained natural tooth - first site in quadrant. ...
Terms matched: 1  -  Score: 21  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
3. NV_BillingGuidelines_PT60.pdf
... units per 60 months three contiguous teeth or tooth bounded spaces per quadrant. D4263 Bone replacement graft â€" retained natural tooth - first site in quadrant. ...
Terms matched: 1  -  Score: 21  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
4. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... SURGL - 3 TEETH PER QUAD 00 NC NC 4 units per 60 months D4263 BONE REPLCE GRAFT FIRST SITE 00 NC NC 4 units per 60 months D4264 BONE ...
Terms matched: 1  -  Score: 119  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
5. NV_BillingGuidelines_PT22-attachmentA.pdf
... SURGL - 3 TEETH PER QUAD 00 NC NC 4 units per 60 months D4263 BONE REPLCE GRAFT FIRST SITE 00 NC NC 4 units per 60 months D4264 BONE ...
Terms matched: 1  -  Score: 119  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
6. NV_Billing_Justice_Initiative.pdf
... only 92552 Pure tone audiometry; air only 92553 Pure tone audiometry; air and bone For codes 92551-92588, multiple codes in this 92567 Tympanometry range may be used ...
Terms matched: 1  -  Score: 13  -  18 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Justice_Initiative.pdf
7. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... D7210 Extraction, erupted tooth requiring removal of Once in a lifetime, same tooth bone and/or sectioning of tooth, and including 00 elevation of mucoperiosteal flap ...
Terms matched: 1  -  Score: 24  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
8. NV_BillingGuidelines_PT22-attachmentB.pdf
... D7210 Extraction, erupted tooth requiring removal of Once in a lifetime, same tooth bone and/or sectioning of tooth, and including 00 elevation of mucoperiosteal flap ...
Terms matched: 1  -  Score: 24  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
9. NV_BillingGuidelines_PT60_2024-0828.pdf
... units per 60 months three contiguous teeth or tooth bounded spaces per quadrant. D4263 Bone replacement graft â€" retained natural tooth - first site in quadrant. ...
Terms matched: 1  -  Score: 21  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
10. NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... D7210 Extraction, erupted tooth requiring removal of Once in a lifetime, same tooth bone and/or sectioning of tooth, and including 00 elevation of mucoperiosteal flap ...
Terms matched: 1  -  Score: 24  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
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