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]

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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 September 2025 Professional Claims. See Web Announcement 3745.

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.

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1. Known_Issues.pdf
... ) and/or error code 1022-(Referring NPI required) when the ordering NPI is entered appropriately with the “DKâ€qualifier. 84 Claims ...
Terms matched: 1  -  Score: 47  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Provider_Enrollment_Information_Booklet.pdf
... Nevada Medicaid and Nevada Check Up programs. To bill for services rendered or to order, prescribe, and refer services to Nevada Medicaid recipients (hereafter referred to ...
Terms matched: 1  -  Score: 211  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... Identification Segment (loop 2110 Service Payment Information REF), if present. 1062 ORDERING NPI REQUIRED 1062 Ordering NPI is required. 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 150  -  04 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_Flex_User_Guide_Individual.pdf
... Welcome and Enrollment Information.... 2 1.2. Provider Information .... 8 1.2.1. Ordering, Prescribing or Referring (OPR) Application or Revalidation Enrollment Type... 14 1.3 ...
Terms matched: 1  -  Score: 94  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
5. NV_Flex_User_Guide_Group.pdf
... organization with which a fiscal agent has entered into a contract, agreement, purchase order, or lease (or leases of real property) to obtain space, ...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
6. Benefit_Enrollment_and_Maintenance_(834).pdf
... section describes how to enroll as an Encounter Trading Partner with Nevada Medicaid. In order to submit and/or receive transactions with Nevada Medicaid, Trading Partners must ...
Terms matched: 1  -  Score: 34  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
7. NV_Billing_General_20250801.pdf
... with Medicaid to render urgent/emergency services. Providers who are enrolled as an Ordering, Prescribing or Referring (OPR) provider cannot bill for services rendered to ...
Terms matched: 1  -  Score: 35  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
8. NV_Billing_General.pdf
... with Medicaid to render urgent/emergency services. Providers who are enrolled as an Ordering, Prescribing or Referring (OPR) provider cannot bill for services rendered to ...
Terms matched: 1  -  Score: 35  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. NV_EVS_User_Manual_Ch7.pdf
... all providers that match the search criteria entered, and if the provider is an Ordering, Prescribing or Referring (OPR) Specialty 400 provider only. 7.1 Gaining ...
Terms matched: 1  -  Score: 56  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch7.pdf
10. NV_EVS_User_Manual_Ch1.pdf
... must then add their information as a delegate and then register as a delegate in order to utilize the secure features in PWP. The website uses data from your ...
Terms matched: 1  -  Score: 38  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
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