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]

Notifications

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.

Scheduled Site Maintenance

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.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... of eligibility will not affect the new way of billing for vaccines, as both ... of eligibility will not affect the new way of billing for vaccines, as both ...
Terms matched: 2  -  Score: 54  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... of eligibility will not affect the new way of billing for vaccines, as both ... of eligibility will not affect the new way of billing for vaccines, as both ...
Terms matched: 2  -  Score: 54  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
... authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Drug ... authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Drug ...
Terms matched: 2  -  Score: 108  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
... authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Drug ... authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Drug ...
Terms matched: 2  -  Score: 108  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
... authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Expedited ... authorization.... 18 Introduction .... 18 Ways to request authorization .... 19 Expedited ...
Terms matched: 2  -  Score: 108  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... paid, or invalid in some other way, federal law requires Medicaid to recover ... paid, or invalid in some other way, federal law requires Medicaid to recover ...
Terms matched: 2  -  Score: 28  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
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Terms matched: 2  -  Score: 28  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... show why a claim was billed the way it was. In accordance with MSM ... show why a claim was billed the way it was. In accordance with MSM ...
Terms matched: 2  -  Score: 66  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
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... , Childcare Navigation Support, On My Way Life Skills Not Not Health Plan of ... , Childcare Navigation Support, On My Way Life Skills Not Not Health Plan of ...
Terms matched: 2  -  Score: 27  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
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