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 June 2026 Professional Claims. See Web Announcement 3964.

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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... Fee-for-Service Coverage, Limitations and Prior Authorization Requirements for the Nevada Medicaid and Nevada Check Up Dental Program - Updated July 1, 2026 - In the following table: ...
Terms matched: 1  -  Score: 232  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
... Fee-for-Service Coverage, Limitations and Prior Authorization Requirements for the Nevada Medicaid and Nevada Check Up Dental Program - Updated March 23, 2026 - In the following table: ...
Terms matched: 1  -  Score: 223  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
... performed in an outpatient/surgical center setting may require prior authorization. †... for the Nevada Medicaid and Nevada Check Up Dental Program), diagnostic, restorative ...
Terms matched: 2  -  Score: 123  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20230327.pdf
... performed in an outpatient/surgical center setting may require prior authorization. †... for the Nevada Medicaid and Nevada Check Up Dental Program services available to adults 21 ...
Terms matched: 2  -  Score: 114  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22.pdf
... (Partial Claim) â€" Audit 5751 will post for claim amounts paying up to the $1 ,000 maximum, leaving non-covered balances subject to recipient ...
Terms matched: 1  -  Score: 63  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
... /encounter is billable per patient per day. An FQHC may be reimbursed for up to three different service type visits per patient per day as long as the ...
Terms matched: 1  -  Score: 42  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260306.pdf
... of benefits and other terms and conditions set forth by the benefit program. How ... included on Nevada Medicaid/Nevada Check Up claims or those claims will be denied ...
Terms matched: 2  -  Score: 23  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
... of benefits and other terms and conditions set forth by the benefit program. How ... included on Nevada Medicaid/Nevada Check Up claims or those claims will be denied ...
Terms matched: 2  -  Score: 23  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2026-0101.pdf
... as a non-covered service or a non-covered setting, then documentation of the denial may ... a timed segment is performed, round up to the next unit. If less ...
Terms matched: 2  -  Score: 370  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
... as a non-covered service or a non-covered setting, then documentation of the denial may ... a timed segment is performed, round up to the next unit. If less ...
Terms matched: 2  -  Score: 370  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
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