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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Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

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. Known_Issues.pdf
... patient liability • Claims are being reviewed for possible Claims amount deducted in full for a member within the further action. same month, for more than ...
Terms matched: 1  -  Score: 11  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_Billing_General.pdf
... A provider’s medical records must contain all information necessary to disclose the full extent of services (i.e., financial and clinical data) . Nevada ...
Terms matched: 1  -  Score: 94  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
3. NV_Billing_General_20250801.pdf
... A provider’s medical records must contain all information necessary to disclose the full extent of services (i.e., financial and clinical data) . Nevada ...
Terms matched: 1  -  Score: 94  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
4. NV_EVS_User_Manual_Ch2.pdf
... services are provided outside of the MCO provider network. The table below shows the full name of the coverage plans displayed in the PWP Coverage field. For information ...
Terms matched: 1  -  Score: 37  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch2.pdf
5. NV_EVS_User_Manual_Ch4.pdf
... . Click Expand All or the “ â€icons to view the full PA details. 2 22 3. Durable Medical Equipment (DME) and ...
Terms matched: 1  -  Score: 33  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
6. NV_EVS_User_Manual_Ch1.pdf
... adding a delegate, the staff member must provide you with: • Full name • Date of birth • Last four digits of ...
Terms matched: 1  -  Score: 26  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
7. web_announcement_Volume 22 Issue 3_20250930.pdf
... All remaining Specialties for Substance Use Treatment Services) For more information, including a full annual schedule and detailed instructions, please visit the QRR website. These reviews ...
Terms matched: 1  -  Score: 13  -  30 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2022%20Issue%203_20250930.pdf
8. web_announcement_3727_20250918.pdf
... Preferred FLEX MONITOR Meters List *National Drug Code Please refer to the webpage for full Diabetic Supplies Preferred Product List Web Announcement 3727 September 18, 2025 Page 1 ...
Terms matched: 1  -  Score: 20  -  18 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3727_20250918.pdf
9. web_announcement_3701_20250825.pdf
... All remaining Specialties for Substance Use Treatment Services) For more information, including a full annual schedule and detailed instructions, please visit the QRR website. These reviews ...
Terms matched: 1  -  Score: 20  -  15 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3701_20250825.pdf
10. web_announcement_3714_20250908.pdf
... One Whole Jaw D0381 Cone Beam Ct Image Capture With Field Of View Of One Full 1 service unit per 36 months Dental Arch - Mandible D0382 Cone Beam Ct ...
Terms matched: 1  -  Score: 38  -  08 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3714_20250908.pdf
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