Nevada Medicaid and Nevada Check Up News (Second 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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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 4 p.m. Pacific Time on Sunday, October 11, 2026, through 3 a.m. Pacific Time on Monday, October 12, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • Provider Flex
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2026 Professional Claims. See Web Announcement 4009.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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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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. NV_BillingGuidelines_PT60.pdf
... components: • Limit 1 unit per day â – ª An occupational profile and medical and therapy history, which includes a brief history including review of ...
Terms matched: 1  -  Score: 119  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
2. NV_BillingGuidelines_PT60_2026-0429.pdf
... components: • Limit 1 unit per day â – ª An occupational profile and medical and therapy history, which includes a brief history including review of ...
Terms matched: 1  -  Score: 119  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
3. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
4. NV_BillingGuidelines_PT60_2025-1216.pdf
... components: • Limit 1 unit per day â – ª An occupational profile and medical and therapy history, which includes a brief history including review of ...
Terms matched: 1  -  Score: 119  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
5. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... incompetent cervix, or maternal history of premature delivery < 35 weeks 76818 Fetal biophysical profile Third • High risk for significant fetal academia with non-stress testing trimester ...
Terms matched: 1  -  Score: 12  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
6. NV_BillingGuidelines_PT20-24-77.pdf
... incompetent cervix, or maternal history of premature delivery < 35 weeks 76818 Fetal biophysical profile Third • High risk for significant fetal academia with non-stress testing trimester ...
Terms matched: 1  -  Score: 12  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
7. NV_BillingGuidelines_PT43.pdf
... ¢ CPT codes 81519 through 81523 (Oncology (breast) mRNA, gene expression profiling) . Prior authorization is required. • CPT codes 36591 and ...
Terms matched: 1  -  Score: 23  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
8. NV_BillingGuidelines_PT43_20251118.pdf
... ¢ CPT codes 81519 through 81523 (Oncology (breast) mRNA, gene expression profiling) . Prior authorization is required. • CPT codes 36591 and ...
Terms matched: 1  -  Score: 23  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20251118.pdf
9. NV_Billing_General.pdf
... Partner User Guide The Trading Partner User Guide provides instruction for establishing a Trading Partner Profile (TPP), selecting the appropriate connectivity method and the testing process. ...
Terms matched: 1  -  Score: 29  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
10. NV_Billing_General_20260101.pdf
... Partner User Guide The Trading Partner User Guide provides instruction for establishing a Trading Partner Profile (TPP), selecting the appropriate connectivity method and the testing process. ...
Terms matched: 1  -  Score: 29  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
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