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]

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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 July 2026 Professional Claims. See Web Announcement 3983.

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.

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1. NV_BillingGuidelines_PT22-attachmentA.pdf
... BITEWINGS - THREE FILMS 00 00 00 1 unit per 6 months D0274 DENTAL BITEWINGS FOUR FILMS 00 00 00 1 unit per 6 months D0277 VERT BITEWINGS-SEV TO EIGHT ...
Terms matched: 1  -  Score: 44  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
... BITEWINGS - THREE FILMS 00 00 00 1 unit per 6 months D0274 DENTAL BITEWINGS FOUR FILMS 00 00 00 1 unit per 6 months D0277 VERT BITEWINGS-SEV TO EIGHT ...
Terms matched: 1  -  Score: 38  -  01 Jul 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_03-23-26.pdf
3. NV_BillingGuidelines_PT34_2026-0101.pdf
... occurrence- and time-based codes may be used but may not exceed a total of four units. • Other Instructions: Other important information regarding the code ...
Terms matched: 1  -  Score: 16  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2026-0101.pdf
4. NV_BillingGuidelines_PT34.pdf
... occurrence- and time-based codes may be used but may not exceed a total of four units. • Other Instructions: Other important information regarding the code ...
Terms matched: 1  -  Score: 16  -  02 Jun 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
5. NV_BillingGuidelines_PT60.pdf
... All Levels QMHP, LCSW, LMFT, LCPC and Additional Instructions: Maximum of four hours per day over a Clinical Interns three-day period (one occurrence) . ...
Terms matched: 1  -  Score: 126  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
6. NV_BillingGuidelines_PT60_2026-0429.pdf
... All Levels QMHP, LCSW, LMFT, LCPC and Additional Instructions: Maximum of four hours per day over a Clinical Interns three-day period (one occurrence) . ...
Terms matched: 1  -  Score: 126  -  19 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2026-0429.pdf
7. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
8. Known_Issues.pdf
... -(Dental Bitewings Three Films) • D0274-(Dental Bitewings Four Films) • D0277-(Vert Bitewings-Sev to Eight) Periapical ...
Terms matched: 1  -  Score: 12  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
9. Error_Code_to_EOB_to_ANSI.pdf
... reached. exceeds our acceptable maximum. 5508 4 UNITS ALLOWED PER 60 ROLLING 5508 FOUR UNITS ALLOWED PER 60 ROLLING 119 Benefit maximum for this time period or N362 ...
Terms matched: 1  -  Score: 114  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
10. NV_BillingGuidelines_PT11.pdf
... the date of admission, exceed two (2 ) calendar days for vaginal or four (4 ) calendar days for medically necessary or emergency cesarean delivery. After ...
Terms matched: 1  -  Score: 26  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
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