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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... 9999 Processed Per Policy 45 Charge exceeds fee schedule/maximum N130 Consult plan benefit ... ) . Usage: Do not use listing for valid procedure codes. this code ...
Terms matched: 2  -  Score: 266  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... payments the FQHC would have received for fee- for-service (FFS) Medicaid recipients ... one unit of the valid encounter code listed below. In order to identify the ...
Terms matched: 2  -  Score: 195  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... payments the FQHC would have received for fee- for-service (FFS) Medicaid recipients ... one unit of the valid encounter code listed below. In order to identify the ...
Terms matched: 2  -  Score: 148  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
... Guardian can contact Gainwell Prior Authorization Customer Service (800) 525-2395 to request the list of codes. How do we explain the need for units when a Board ...
Terms matched: 1  -  Score: 39  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
... the PWP at www.medicaid.nv.gov through the Search Fee Schedule function, which can be accessed ... the Nevada Medicaid website for a complete list of Medicaid covered services, limitations and ...
Terms matched: 2  -  Score: 86  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41.pdf
... Web Portal at www.medicaid.nv.gov through the Search Fee Schedule function, which can be accessed ... on the DHCFP website for a complete list of Medicaid covered services, limitations and ...
Terms matched: 2  -  Score: 85  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41_20241218.pdf
... enrollment is requested, the applicant shall provide a letter of justification, and a list of all claims associated with the retroactive time. Please note that this does ...
Terms matched: 1  -  Score: 158  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... €™s invoice may be required to substantiate payment by Medicaid per PT 33 fee schedule, and an unaltered complete order form specific to the manufacturer and model ...
Terms matched: 1  -  Score: 26  -  23 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-1D.pdf
... 16 Sample Medicaid card .... 16 Fee For Service vs. Managed Care ... ... œClaims Processing and 8 Beyondâ€, list of potential 8th digit characters for paid ...
Terms matched: 2  -  Score: 292  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
... 15 Sample Medicaid card .... 15 Fee For Service vs. Managed Care ... ... œClaims Processing and 8 Beyondâ€, list of potential 8th digit characters for paid ...
Terms matched: 2  -  Score: 288  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
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