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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

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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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.

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1. Known_Issues.pdf
... 24 Units Alwd/Day) automatically re-processed. • 5537-(One Unit Allowed Per Day) • 5538-(Thirty-Two Units Allowed ...
Terms matched: 1  -  Score: 130  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_EVS_User_Manual_Ch3.pdf
... , institutional, and professional claims. To begin the claim submission process, select one of the submit claim options from the Claims submenu, or click on the ...
Terms matched: 1  -  Score: 75  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
3. NV_BillingGuidelines_PT14_online_011226.pdf
... the same month; see the example below); or • If one hour, four units, were performed on January 1 and two hours, ...
Terms matched: 1  -  Score: 305  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
4. NV_BillingGuidelines_PT14.pdf
... the same month; see the example below); or • If one hour, four units, were performed on January 1 and two hours, ...
Terms matched: 1  -  Score: 305  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
5. NV_BillingGuidelines_PT26_20260112.pdf
... a combination of 26 sessions of group, individual and/or family therapy in one year without prior authorization. A psychologist is responsible for requesting any subsequent authorizations ...
Terms matched: 1  -  Score: 115  -  13 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20260112.pdf
6. NV_BillingGuidelines_PT26.pdf
... a combination of 26 sessions of group, individual and/or family therapy in one year without prior authorization. A psychologist is responsible for requesting any subsequent authorizations ...
Terms matched: 1  -  Score: 115  -  13 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... Code = POA) 3299 HOLIDAY PAY TV MOD BILLED - NOT A 2001 Deny ... critical edit. documentation. At least one Remark Code Critical edits should not be ...
Terms matched: 2  -  Score: 416  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. Provider_Enrollment_Information_Booklet.pdf
... has their current email and mailing addresses on file. Providers may revalidate up to one year in advance of their revalidation due date. Login to the Provider Web ...
Terms matched: 1  -  Score: 136  -  09 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
9. web_announcement_3820_20260120.pdf
... of Care (LOC), and Nursing Facility Tracking (NFT) Requests Under One Profile Effective March 16, 2026, Nevada Medicaid and Nevada Check Up providers ...
Terms matched: 1  -  Score: 37  -  06 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3820_20260120.pdf
10. web_announcement_3822_20260123.pdf
... each month. All providers, delegates and/or staff are invited to attend one or more of the training sessions listed below that are being held in February ...
Terms matched: 1  -  Score: 23  -  05 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3822_20260123.pdf
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