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 April 2026 Professional Claims. See Web Announcement 3915.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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. Pregnancy_Presumptive_Eligibility_Addendum.pdf
... to presumptively eligible pregnant individuals is limited to ambulatory prenatal care. The following provider types and specialties may be considered qualified entities: Provider Type Specialty Description 17 166 ...
Terms matched: 1  -  Score: 80  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Addendum.pdf
2. Pregnancy_Presumptive_Eligibility_Instructions.pdf
... table shows the Nevada Medicaid enrolled provider types (PT) that may request to ... . Pharmacy benefits may take up to 48 hours to go into effect after presumptive ...
Terms matched: 2  -  Score: 72  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Instructions.pdf
3. PT_34_Therapy_Tip_Sheet.pdf
... Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 ... both your request and physician's order. FA-7 requests can ... Prior Authorization Request) Process Type will be OUTPT M ...
Terms matched: 3  -  Score: 135  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
4. FA-11.pdf
... notify sender immediately and shall destroy all information received. DATE OF REQUEST: REQUEST TYPE: Initial Prior Authorization Concurrent Authorization Unscheduled Revision Retrospective Authorization â€" Date ...
Terms matched: 1  -  Score: 23  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
5. Known_Issues.pdf
... NPI required) when the ordering NPI is entered appropriately ... Some claims submitted by provider types 24- †... Periapical EA Add Film) 48 Claims, Some claims ...
Terms matched: 3  -  Score: 507  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
6. Error_Code_to_EOB_to_ANSI.pdf
... , if present. 1062 ORDERING NPI REQUIRED 1062 Ordering ... , if present. 273 TYPE OF BILL MISSING 4100 ... /05/2026 Page 48 of 185 Claim Error ...
Terms matched: 3  -  Score: 586  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
7. NV_BillingGuidelines_PT11.pdf
... when a physician writes the inpatient admission order. • Obstetric or newborn ... Provider Type 11 Billing Guide Hospital, Inpatient Program Overview A hospital (other ...
Terms matched: 2  -  Score: 276  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
8. NV_BillingGuidelines_PT11_online_082725.pdf
... when a physician writes the inpatient admission order. • Obstetric or newborn ... Provider Type 11 Billing Guide Hospital, Inpatient Program Overview A hospital (other ...
Terms matched: 2  -  Score: 276  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
9. DME_Enrollment_Moratorium_Exemption_Request.pdf
... Administrator Joe Lombardo Reno, Nevada 89521 Governor NVHA.NV.GOV Enrollment Moratorium Exemption Request Form Provider Type 33 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) ...
Terms matched: 1  -  Score: 23  -  30 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DME_Enrollment_Moratorium_Exemption_Request.pdf
10. NV_BillingGuidelines_PT60_2025-1216.pdf
... 3 Units .... 4 Ordering, Prescribing and Referring ... Provider Type 60 Billing Guide School Health Services ( ... 08/28/2024 48 / 78 Provider Type ...
Terms matched: 3  -  Score: 648  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
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