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]

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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.

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1. Provider_Enrollment_Information_Booklet.pdf
... the retroactive time. Please note that this does not extend the timely filing policy set forth in Medicaid Services Manual Chapter 100 Medicaid Program. The list of claims ...
Terms matched: 1  -  Score: 28  -  09 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
2. Known_Issues.pdf
... without using the copy System.NullReferenceException: Object functionality, until a resolution is reference not set to an instance of an object in place. 10 Web Portal, The ...
Terms matched: 1  -  Score: 14  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_EnrollmentCriteria_PT17_Spec188.pdf
... to the State of Nevada at regular intervals. Extracts will require customized reports in set formats to meet State of Nevada requirements. It is imperative that Electronic Health ...
Terms matched: 1  -  Score: 20  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
4. NV_BillingGuidelines_PT14_online_030525.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Updated: 03/05/2025 Provider ...
Terms matched: 1  -  Score: 76  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
5. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... for Nursing Mothers with infants up to 12 months of age. In the outpatient setting, PT 20 (Physician), PT 24 (APRN), and ...
Terms matched: 1  -  Score: 24  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
6. NV_BillingGuidelines_PT26_20251013.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Request timelines • Initial request for ...
Terms matched: 1  -  Score: 20  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20251013.pdf
7. NV_BillingGuidelines_PT14.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Updated: 01/12/2026 Provider ...
Terms matched: 1  -  Score: 70  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
8. NV_BillingGuidelines_PT20-24-77.pdf
... for Nursing Mothers with infants up to 12 months of age . In the outpatient setting, PT 20 (Physician), PT 24 (APRN), and ...
Terms matched: 1  -  Score: 24  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
9. NV_BillingGuidelines_PT26.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Request timelines • Initial request for ...
Terms matched: 1  -  Score: 20  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26.pdf
10. Error_Code_to_EOB_to_ANSI.pdf
... PLEASE CONTACT THE occurrence has been reached. made for same/similar procedure within set CARE COORDINATOR time frame. 3353 SPECIALIZED FOSTER CARE CHECKLIST 3352 ELIGIBILITY CHECKLIST NOT ...
Terms matched: 1  -  Score: 312  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
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