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. Known_Issues.pdf
... Provider Identifier (NPI) are obtain a copy of their RA. unable to view all of their Remittance Advice (RA) documents on the Web Portal. ...
Terms matched: 1  -  Score: 57  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_BillingGuidelines_PT22-attachmentA.pdf
... IMAGE CAPTURE WITH LIMITED 00 00 00 1 service unit per 36 months FIELD OF VIEW - LESS THAN ONE WHOLE JAW D0381 CONE BEAM CT IMAGE CAPTURE WITH FIELD ...
Terms matched: 1  -  Score: 47  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
3. NV_EnrollmentCriteria_PT17_Spec188.pdf
... 188 must first watch the following: • Informational workshop which can be viewed on YouTube. • CCBHC enrollment webinar presented by the Center for ...
Terms matched: 1  -  Score: 23  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
4. NV_EVS_User_Manual_Ch10.pdf
... Available to Download section. 3. Click the Report ID hyperlink to download and view the letter. 4 10.2.2 Prior Authorization Attachments The following Prior Authorization Attachments are ...
Terms matched: 1  -  Score: 104  -  21 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch10.pdf
5. web_announcement_3803_20251229.pdf
... ¢ Due to the recent system update, providers will no longer be able to view Prior Authorizations (PAs) in the Provider Web Portal (PWP) for ...
Terms matched: 1  -  Score: 23  -  29 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3803_20251229.pdf
6. NV_BillingGuidelines_PT60.pdf
... unit per 36 months D0364 Cone beam CT capture and interpretation with limited field of view - less than one • Limit of 1 unit per 6 months ...
Terms matched: 1  -  Score: 37  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. NV_BillingGuidelines_PT60_2024-0828.pdf
... unit per 36 months D0364 Cone beam CT capture and interpretation with limited field of view - less than one • Limit of 1 unit per 6 months ...
Terms matched: 1  -  Score: 37  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
8. NV_EVS_User_Manual_Ch4.pdf
... . Checking prior authorization status.... 22 4.9. Checking PA status through member focused viewing .... 31 4.10. Maintain Favorite Providers .... 38 4.11. Logging ...
Terms matched: 1  -  Score: 309  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch4.pdf
9. Consent_to_Electronic_Delivery_of_1099.pdf
... currently has on file. 3. Users can verify their electronic delivery selection by viewing the demographic panel in the Provider Web Portal (PWP) . If you ...
Terms matched: 1  -  Score: 21  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Consent_to_Electronic_Delivery_of_1099.pdf
10. NV_BillingGuidelines_PT36_20111001.pdf
... Therapy, (max 30 min): 97110 ï ‚ X-Ray (medically necessary views): 72010-72040 ï ‚ Spinal Manipulation: 98940-98942 The chiropractic manual manipulative treatment ...
Terms matched: 1  -  Score: 20  -  28 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT36_20111001.pdf
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