Nevada Medicaid and Nevada Check Up News (First Quarter 2026 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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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 https://NevadaMedicaid.nv.gov/ and the Billing Guide for your provider type at www.medicaid.nv.gov.

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1. Known_Issues.pdf
... or • Once resolved, claims will be Provider type 32 Therapeutic to Residence) or GR-(Hospital- automatically reprocessed. Professional and based ESRD ...
Terms matched: 1  -  Score: 21  -  08 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... error(s ) . Usage: Do not use the facility where the patient resides. this code for claims attachment(s )/ other documentation. At ...
Terms matched: 1  -  Score: 11  -  08 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... - Peer Support Out-of-State Catchment Providers When medical care within Nevada is unavailable for recipients residing near state borders, the contiguous out- of-state physician/clinic is considered ...
Terms matched: 1  -  Score: 11  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. NV_BillingGuidelines_PT87_Spec250_090324.pdf
... • Socioeconomic status • Sexual orientation • Place of residence • Any social conditions that affect the patient • The ...
Terms matched: 1  -  Score: 23  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250_090324.pdf
5. NV_Billing_General_20260101.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
6. NV_Billing_General.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_EVS_User_Manual_Ch1.pdf
... able to access the Pre- Allows you to perform Pre- Admission Screening and Resident Admission Screening and Resident Review (PASRR) link. Reviews. Presumptive Eligibility ...
Terms matched: 1  -  Score: 24  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
8. NV_BillingGuidelines_PT85_Spec320_Checklist.pdf
... : ____ The recipient must meet all the following criteria â Medicaid eligible â Resides in Nevada â Consent documentation complete â P04.3 or Q86.0 ICD-10 code diagnosis In ...
Terms matched: 1  -  Score: 21  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320_Checklist.pdf
9. web_announcement_3820_20260120.pdf
... Hospitals under PTs 10, 11, 13, and 14: Pre-Admission Screening and Resident Review (PASRR), Level of Care (LOC), and Nursing ...
Terms matched: 1  -  Score: 37  -  06 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3820_20260120.pdf
10. NV_Billing_General_20251215.pdf
... Medical/Surgical, Mental Health, Ocular, Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, Private Duty Nursing and Psychiatric Residential Treatment ...
Terms matched: 1  -  Score: 23  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
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