Nevada Medicaid and Nevada Check Up News (Third 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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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. Provider_Enrollment_Information_Booklet.pdf
... œEnrollment Types and Key Enrollment Requirementsâ€) . To qualify, the provider must meet all federal requirements and Nevada Medicaid requirements. Providers (Individuals/Groups) ...
Terms matched: 1  -  Score: 23  -  23 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
2. Known_Issues.pdf
... Claims and already adjusted/voided) and/or 0075-(adjustment Workgroup Meeting on 09/16/2019, it Professional denied-original payment request already was ...
Terms matched: 1  -  Score: 11  -  23 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_BillingGuidelines_PT60.pdf
... the POC. • Deemed medically necessary and appropriate. • Meet any Ordering, Prescribing and Referring (OPR) requirements for the service being ...
Terms matched: 1  -  Score: 93  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
4. NV_BillingGuidelines_PT60_2024-0828.pdf
... the POC. • Deemed medically necessary and appropriate. • Meet any Ordering, Prescribing and Referring (OPR) requirements for the service being ...
Terms matched: 1  -  Score: 93  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
5. FA-11B.pdf
... an enrolled Federally Qualified Health Center (FQHC) (that assumes clinical liability and meets the criteria of a Certified Mental Health Clinic) with an enrolled provider type ...
Terms matched: 1  -  Score: 23  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11B.pdf
6. NV_BillingGuidelines_PT33_20250623.pdf
... recipient’s condition, using the least costly and equally effective alternative to meet the recipient’s needs. Providers are responsible to know the policies ...
Terms matched: 1  -  Score: 44  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
7. NV_Billing_General.pdf
... (see “Required Documentsâ€) . To qualify, the provider must meet all federal requirements, Nevada Medicaid state requirements and be a Medicaid provider in ...
Terms matched: 1  -  Score: 52  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
8. NV_BillingGuidelines_PT33.pdf
... recipient’s condition, using the least costly and equally effective alternative to meet the recipient’s needs. Providers are responsible to know the policies ...
Terms matched: 1  -  Score: 44  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
9. Error_Code_to_EOB_to_ANSI.pdf
... Information REF), if present. 702 MEMBER AGE RESTRICTION 1121 Member does not meet the age restriction for 6 The procedure/revenue code is inconsistent N129 Not ...
Terms matched: 1  -  Score: 90  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
10. NV_Enrollment_AnnualAttestation_PT63.pdf
... of Participation (CoP) for the use of restraint and seclusion that PRTFs must meet to provide, or continue to provide, this Medicaid inpatient benefit. The ...
Terms matched: 1  -  Score: 100  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Enrollment_AnnualAttestation_PT63.pdf
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