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

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.

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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... Hospitals under PTs 10, 11, 13, and 14: Pre-Admission Screening and Resident Review (PASRR), Level of Care (LOC), and Nursing ...
Terms matched: 1  -  Score: 37  -  06 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3820_20260120.pdf
... ) with Modifier DR-(Diagnostic or needed. Provider type 32 Therapeutic to Residence) or GR-(Hospital-based • Once resolved, claims will ...
Terms matched: 1  -  Score: 21  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... - Peer Support Out-of-State Catchment Providers When medical care within Nevada is unavailable for recipients residing near state borders, the contiguous out- of-state physician/clinic is considered ...
Terms matched: 1  -  Score: 11  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... error(s ) . Usage: Do not use the facility where the patient resides. this code for claims attachment(s )/ other documentation. At ...
Terms matched: 1  -  Score: 11  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
... Limitations T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a • 15 minutes = 1 unit hospital, nursing facility ...
Terms matched: 1  -  Score: 11  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... Limitations T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a • 15 minutes = 1 unit hospital, nursing facility ...
Terms matched: 1  -  Score: 11  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
... to provide, this Medicaid inpatient benefit. The CoP specifies requirements designed to protect residents against the improper use of restraint and seclusion. The Medicaid Program Use of ...
Terms matched: 1  -  Score: 80  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Enrollment_AnnualAttestation_PT63.pdf
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