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. web_announcement_3820_20260120.pdf
... 2026, Nevada Medicaid and Nevada Check Up providers will be able to create and ... , and 14: Pre-Admission Screening and Resident Review (PASRR), Level of ...
Terms matched: 2  -  Score: 56  -  06 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3820_20260120.pdf
2. Known_Issues.pdf
... a resolution is reference not set to an instance of ... calendar year-PA override), up with impacted providers once ... Provider type 32 Therapeutic to Residence) or GR- ...
Terms matched: 3  -  Score: 68  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... soft Incidental already part of another procedure 00 tissue D7910 Suture of recent small wounds up to 5 cm 00 None D7961 Buccal / Labial Frenectomy (Frenulectomy) 00 ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
4. NV_BillingGuidelines_PT22-attachmentB.pdf
... soft Incidental already part of another procedure 00 tissue D7910 Suture of recent small wounds up to 5 cm 00 None D7961 Buccal / Labial Frenectomy (Frenulectomy) 00 ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
5. NV_BillingGuidelines_PT22-attachmentA.pdf
... Fee-for-Service Coverage, Limitations and Prior Authorization Requirements for the Nevada Medicaid and Nevada Check Up Dental Program - Updated January 29, 2026 - In the following table: ...
Terms matched: 1  -  Score: 223  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
6. 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
7. Provider_Enrollment_Information_Booklet.pdf
... extend the timely filing policy set forth in Medicaid Services ... Nevada Medicaid and Nevada Check Up programs. To bill ... Nevada is unavailable for recipients residing near state borders, ...
Terms matched: 3  -  Score: 88  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
8. NV_EVS_User_Manual_Ch10.pdf
... 17/2025) Chapter 10. Report Download The Nevada Medicaid and Nevada Check Up Provider Web Portal (formerly EVS) allows providers, or their delegates, ...
Terms matched: 1  -  Score: 23  -  21 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch10.pdf
9. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... months of age. In the outpatient setting, PT 20 (Physician), ... ) Policy Nevada Medicaid and Nevada Check Up reimburse Physicians, Advanced Practice Registered Nurses ...
Terms matched: 2  -  Score: 190  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
10. NV_BillingGuidelines_PT14_online_030525.pdf
... of benefits and other terms and conditions set forth by the benefit program. Updated ... Mental Health Assessment by non- Covered up to 4 QMHP, Use this code ...
Terms matched: 2  -  Score: 121  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
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