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]

Notifications

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 September 2026 Professional Claims. See Web Announcement 4031.

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.

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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... of current CPT codes, service limitations and MUEs are applied when billing claims. Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 88  -  13 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85.pdf
... of current CPT codes, service limitations and MUEs are applied when billing claims. Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 84  -  13 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_20260727.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  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.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  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
... /EOB/ANSI Code Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 1062 ORDERING NPI REQUIRED 1062 Ordering NPI is required. 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 150  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... codes can be used for induction visits. • Codes are listed in order of increasing length of time with patient and/or severity of the problems ...
Terms matched: 1  -  Score: 14  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec707_online_073126.pdf
... codes can be used for induction visits. • Codes are listed in order of increasing length of time with patient and/or severity of the problems ...
Terms matched: 1  -  Score: 14  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec708.pdf
... codes can be used for induction visits. • Codes are listed in order of increasing length of time with patient and/or severity of the problems ...
Terms matched: 1  -  Score: 14  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec707.pdf
... codes can be used for induction visits. • Codes are listed in order of increasing length of time with patient and/or severity of the problems ...
Terms matched: 1  -  Score: 14  -  30 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT93_Spec708_online_073126.pdf
... (specialties 310, 311, 312, 314) Note: Providers enrolled as Ordering, Prescribing, Referring (OPR), specialty 400 are not eligible to ...
Terms matched: 1  -  Score: 20  -  28 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4018_20260928.pdf
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