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

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

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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... 9 UNITS ALLOWED PER 11 ROLLING 5601 NINE UNITS ALLOWED PER ROLLING 119 Benefit maximum ... not use the facility where the patient resides. this code for claims attachment( ...
Terms matched: 2  -  Score: 31  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... showing all board members (minimum of nine) to include date of birth and ... care within Nevada is unavailable for recipients residing near state borders, the contiguous out ...
Terms matched: 2  -  Score: 21  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.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  -  20 Feb 2026  -  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  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
... able to access the Pre- Allows you to perform Pre- Admission Screening and Resident Admission Screening and Resident Review (PASRR) link. Reviews. Presumptive Eligibility ...
Terms matched: 1  -  Score: 24  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
... : ____ The recipient must meet all the following criteria â Medicaid eligible â Resides in Nevada â Consent documentation complete â P04.3 or Q86.0 ICD-10 code diagnosis In ...
Terms matched: 1  -  Score: 21  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320_Checklist.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  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... 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
... 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
... 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
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