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 June 2026 Professional Claims. See Web Announcement 3964.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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. 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
2. Benefit_Enrollment_and_Maintenance_(834).pdf
... in format CCYYMMDD 139 2200 DTP03 Disability Eligibility Date 8 (CCYYMMDD) 140 2300 HD Health Coverage 140-141 2300 HD01 Maintenance Type Code 3/3 Maintenance Type Codes ...
Terms matched: 1  -  Score: 97  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
3. web_announcement_3696_20250815.pdf
... Section H. â€" Anti-Angiogenic Ophthalmic Agents: Eylea®, Eylea® HD (intravitreal); Section J. â€" Antineoplastic-Anti-Programmed Cell Death Receptor-1 ...
Terms matched: 1  -  Score: 20  -  15 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3696_20250815.pdf
4. web_announcement_3687_20250804.pdf
... (idursulfase) • Anti-Angiogenic Ophthalmic Agents: Eylea®, Eylea® HD (intravitreal) • Antineoplastic-Anti-Programmed Cell Death Receptor-1 (PD- 1 ...
Terms matched: 1  -  Score: 20  -  04 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3687_20250804.pdf
5. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
6. Inflammatory_Bowel_Disease_Agents_2017-09.pdf
... (mesalamine) ER capsule Salix Pharmaceuticals 10/31/2008 - ASACOL® HD (mesalamine) DR tablet various 05/29/2008 ï AZULFIDINE® ...
Terms matched: 1  -  Score: 96  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inflammatory_Bowel_Disease_Agents_2017-09.pdf
7. HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
... JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, ... Lewis Ef, Fox KA, White HD, et al. Early intensive vs ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
8. HMG CoA Reductase Inhibitors.pdf
... JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, ... Lewis Ef, Fox KA, White HD, et al. Early intensive vs ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG%20CoA%20Reductase%20Inhibitors.pdf
9. Erythropoiesis-Stimulating Agents.pdf
... 0.16 g/dL (95% on the total weekly dose of stable on HD for baseline to CI, -0.06 to 0.38; P value not reported) ...
Terms matched: 1  -  Score: 36  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Erythropoiesis-Stimulating%20Agents.pdf
10. Encounter NCPDP Companion Guide - Mod n061818.pdf
... is excessive for the single time period for which the drug is being prescribed. HD High Dose â€" Detects drug doses that fall above the standard dosing ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter%20NCPDP%20Companion%20Guide%20-%20Mod%20n061818.pdf
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