Nevada Medicaid and Nevada Check Up News (Fourth 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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EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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. NV_EnrollmentChecklist_PT93_Spec704.pdf
... , managing employees, and all other employees providing direct services have a fingerprint-based criminal background check through the Department of Public Safety and Federal Bureau of Investigation. Failure ...
Terms matched: 1  -  Score: 20  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
2. NV_EnrollmentCriteria_PT17_Spec188.pdf
... utilizing or will adopt. ii. Provide the name and contact information for a point of contact with the EHR vendor for follow-up questions. iii. If extracts ...
Terms matched: 1  -  Score: 36  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentCriteria_PT17_Spec188.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... . 20 Out of State Providers Urgent/Emergency Services .... 21 Fingerprint-based Criminal Background Check (FCBC) .... 22 License Updates and Voluntary Termination Requests ... ...
Terms matched: 1  -  Score: 51  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... Z34.00, Z34.80, Z34.90, or Z3A.0 - Z3A.49) . Diagnosis’ pointed on the claim line should indicate the complication/reason for the additional visit ...
Terms matched: 1  -  Score: 12  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
5. NV_BillingGuidelines_PT20-24-77.pdf
... Z34.00, Z34.80, Z34.90, or Z3A.0 - Z3A.49) . Diagnosis’ pointed on the claim line should indicate the complication/reason for the additional visit ...
Terms matched: 1  -  Score: 12  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
6. Error_Code_to_EOB_to_ANSI.pdf
... (loop 2110 Service Payment Information REF), if present. 3299 HOLIDAY PAY TV MOD BILLED - NOT A 2001 Deny Holiday Pay TV Modifier when not a ...
Terms matched: 1  -  Score: 22  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
7. NV_Billing_General_20251017.pdf
... within 90 calendar days, and ABA services, which can be requested at any point within the date range requested on the PA. For a Reconsideration request, ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
8. NV_Billing_General_20251215.pdf
... within 90 calendar days, and ABA services, which can be requested at any point within the date range requested on the PA. For a Reconsideration request, ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
9. NV_Billing_General.pdf
... within 90 calendar days, and ABA services, which can be requested at any point within the date range requested on the PA. For a Reconsideration request, ...
Terms matched: 1  -  Score: 11  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
10. NV_BillingGuidelines_PT85.pdf
... retrospectively. • Reconsideration request: The provider may request Reconsideration at any point within the date range requested on the PA. Billing and Claim Instructions â ...
Terms matched: 1  -  Score: 14  -  22 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85.pdf
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