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

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 Third Quarter of 2025. See Web Announcement 3758.

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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... , until a resolution is reference not set to an instance of an object in ... €¢ D0272-(Dental Bitewings Two Films) • D0273- ...
Terms matched: 2  -  Score: 70  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... surface, anterior 00 1 unit per 36 months per tooth D2331 Resin-based composite, two surfaces, anterior 00 1 unit per 36 months per tooth D2332 Resin-based composite ...
Terms matched: 1  -  Score: 29  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... surface, anterior 00 1 unit per 36 months per tooth D2331 Resin-based composite, two surfaces, anterior 00 1 unit per 36 months per tooth Updated 02/ ...
Terms matched: 1  -  Score: 29  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
... not be billed on the same date of service as D0373. D0272 DENTAL BITEWINGS TWO FILMS 00 00 00 1 unit per 6 months D0273 BITEWINGS - THREE FILMS ...
Terms matched: 1  -  Score: 46  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
... . Extracts will require customized reports in set formats to meet State of Nevada requirements ... the University of Nevada Reno. Step Two Providers must be able to document that ...
Terms matched: 2  -  Score: 55  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
... does not extend the timely filing policy set forth in Medicaid Services Manual Chapter 100 ... billing and enrollment practices. There are two types of healthcare provider NPI numbers: ...
Terms matched: 2  -  Score: 41  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... of benefits and other terms and conditions set forth by the benefit program. Updated ... on January 1 and January 10 (two days within the same month; see ...
Terms matched: 2  -  Score: 199  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
... months of age. In the outpatient setting, PT 20 (Physician), ... . Endoscopic payment methodology In situations when two series of endoscopies are performed, the ...
Terms matched: 2  -  Score: 64  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Request timelines • Initial request for ...
Terms matched: 1  -  Score: 20  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20251013.pdf
... of benefits and other terms and conditions set forth by the benefit program. Updated ... on January 1 and January 10 (two days within the same month; see ...
Terms matched: 2  -  Score: 186  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
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