Nevada Medicaid and Nevada Check Up News (Third 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

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 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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... - 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  -  23 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
... ) with Modifier DR-(Diagnostic or needed. Provider type 32 Therapeutic to Residence) or GR-(Hospital-based • Once resolved, claims will ...
Terms matched: 1  -  Score: 21  -  23 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... Limitations T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a • 15 minutes = 1 unit hospital, nursing facility ...
Terms matched: 1  -  Score: 11  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... Limitations T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a • 15 minutes = 1 unit hospital, nursing facility ...
Terms matched: 1  -  Score: 11  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ... , Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, ...
Terms matched: 2  -  Score: 45  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.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  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... to provide, this Medicaid inpatient benefit. The CoP specifies requirements designed to protect residents against the improper use of restraint and seclusion. The Medicaid Program Use of ...
Terms matched: 1  -  Score: 80  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Enrollment_AnnualAttestation_PT63.pdf
... their health plan to arrange travel for care-related purposes. Urban Washoe and Clark County residents, please continue to schedule with the Non-Emergency Transportation vendor, MTM, at ...
Terms matched: 1  -  Score: 12  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
... 2 EM = Email 66 2100A PER06 Email 1/256 68 2100A N3 Member Residence Street Address 68 2100A N301 Subscriber Address 1/55 68 2100A N302 Subscriber ...
Terms matched: 1  -  Score: 53  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
... throughout per the implementation of the All modernized Medicaid Management Information System (MMIS) ... , Out-of-State services, Pre-Admission Screening and Resident Review (PASRR) Level II, ...
Terms matched: 2  -  Score: 45  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
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