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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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 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. 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
2. 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
3. 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
4. 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
5. 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  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
6. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... permanent teeth 1 unit per 36 months per tooth 00 only D2330 Resin-based composite, one surface, anterior 00 1 unit per 36 months per tooth D2331 Resin-based composite ...
Terms matched: 1  -  Score: 42  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
7. NV_BillingGuidelines_PT22-attachmentB.pdf
... permanent teeth 1 unit per 36 months per tooth 00 only D2330 Resin-based composite, one surface, anterior 00 1 unit per 36 months per tooth D2331 Resin-based composite ...
Terms matched: 1  -  Score: 42  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
8. NV_BillingGuidelines_PT22-attachmentA.pdf
... 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 OF 00 00 00 ...
Terms matched: 1  -  Score: 60  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
9. NV_EnrollmentChecklist_PT93_Spec704.pdf
... Date: ____ National Provider Identifier (NPI): ____ Please check one of the following boxes. Updates to Clinical Supervisors of the agency are reported ...
Terms matched: 1  -  Score: 23  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
10. NV_EnrollmentCriteria_PT17_Spec188.pdf
... to all qualified providers who have followed the steps and process outlined herein. Step One All providers seeking to enroll as a PT 17 specialty 188 must first watch ...
Terms matched: 1  -  Score: 26  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
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