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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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 4 p.m. Pacific Time on Sunday, October 11, 2026, through 3 a.m. Pacific Time on Monday, October 12, 2026, for scheduled maintenance:
  • All secure Provider Web Portal (PWP) functions
  • Provider Flex
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider Pre-Admission Screening Resident Review (PASRR)

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 August 2026 Professional Claims. See Web Announcement 4009.

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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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.

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1. NV_Billing_General.pdf
... eligibility. QMB recipients who are also eligible for full Medicaid benefits have a QMB Plus eligibility status. QMB recipients not eligible for Medicaid benefits have a QMB Only ...
Terms matched: 1  -  Score: 10  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
2. NV_Billing_General_20260710.pdf
... eligibility. QMB recipients who are also eligible for full Medicaid benefits have a QMB Plus eligibility status. QMB recipients not eligible for Medicaid benefits have a QMB Only ...
Terms matched: 1  -  Score: 10  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
3. Error_Code_to_EOB_to_ANSI.pdf
... (loop 2110 Service Payment Information REF), if present. 3299 HOLIDAY PAY TV MOD BILLED - NOT A HOLIDAY - 2001 Deny Holiday Pay TV Modifier when ...
Terms matched: 1  -  Score: 22  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NCPDP_Encounter_Companion_Guide.pdf
... DF Drug-Food interaction â€" Indicates interactions between a drug and certain foods. DI Drug Incompatibility â€" Indicates physical and chemical incompatibilities between two or more ...
Terms matched: 1  -  Score: 11  -  15 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NCPDP_Encounter_Companion_Guide.pdf
5. Known_Issues.pdf
... (Spherocylinder, • Once resolved, claims will be single vision, plus or minus 4.25d to plus or automatically reprocessed. minus 7.00 sphere, 0.12 ...
Terms matched: 1  -  Score: 37  -  01 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
6. NV_EVS_User_Manual_Ch3.pdf
... that panel. 5 Click Expand All to expand all panels, or click the plus icons on each panel to open only that panel. Diagnosis Codes The first ...
Terms matched: 1  -  Score: 102  -  19 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
7. NV_EVS_User_Manual_Ch8.pdf
... below: â – ª 10-digit Provider NPI/API example 0000000000 â – ª Plus 11-digit Recipient Medicaid ID example 11111100000 â – ª Plus 6- or 8-digit ...
Terms matched: 1  -  Score: 50  -  19 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch8.pdf
8. NV_BillingGuidelines_PT33_20260730.pdf
... or manufacturer’s invoice that clearly identifies MSRP; b) acquisition cost plus 20%, verifiable with manufacturer’s invoice; or c) ...
Terms matched: 1  -  Score: 16  -  14 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20260730.pdf
9. NV_BillingGuidelines_PT33.pdf
... or manufacturer’s invoice that clearly identifies MSRP; b) acquisition cost plus 20%, verifiable with manufacturer’s invoice; or c) ...
Terms matched: 1  -  Score: 16  -  14 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
10. Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
... , FI, HM, LM, MA, MB, MC, OF, TV, VA, WC, ZZ Medicaid MC 2 The value sent at this ...
Terms matched: 1  -  Score: 21  -  04 Aug 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
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