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.
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For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

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

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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_BillingGuidelines_PT14_online_030525.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Updated: 03/05/2025 Provider ...
Terms matched: 1  -  Score: 76  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
2. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... for Nursing Mothers with infants up to 12 months of age. In the outpatient setting, PT 20 (Physician), PT 24 (APRN), and ...
Terms matched: 1  -  Score: 24  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
3. NV_BillingGuidelines_PT26_20251013.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Request timelines • Initial request for ...
Terms matched: 1  -  Score: 20  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20251013.pdf
4. NV_BillingGuidelines_PT14.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Updated: 01/12/2026 Provider ...
Terms matched: 1  -  Score: 70  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
5. NV_BillingGuidelines_PT20-24-77.pdf
... for Nursing Mothers with infants up to 12 months of age . In the outpatient setting, PT 20 (Physician), PT 24 (APRN), and ...
Terms matched: 1  -  Score: 24  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
6. NV_BillingGuidelines_PT26.pdf
... contractual terms, limitations, exclusions, coordination of benefits and other terms and conditions set forth by the benefit program. Request timelines • Initial request for ...
Terms matched: 1  -  Score: 20  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... PLEASE CONTACT THE occurrence has been reached. made for same/similar procedure within set CARE COORDINATOR time frame. 3353 SPECIALIZED FOSTER CARE CHECKLIST 3352 ELIGIBILITY CHECKLIST NOT ...
Terms matched: 1  -  Score: 312  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. Known_Issues.pdf
... , until a resolution is reference not set to an instance of an object in ... copy of their RA. unable to view all of their Remittance Advice (RA ...
Terms matched: 2  -  Score: 55  -  07 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
9. NV_BillingGuidelines_PT22-attachmentA.pdf
... IMAGE CAPTURE WITH LIMITED 00 00 00 1 service unit per 36 months FIELD OF VIEW - LESS THAN ONE WHOLE JAW D0381 CONE BEAM CT IMAGE CAPTURE WITH FIELD ...
Terms matched: 1  -  Score: 47  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
10. NV_Billing_General_20251017.pdf
... /Recipient files Provider Each provider is responsible for: • Following regulations set forth in the Medicaid Services Manual (see Medicaid Services Manual (MSM) ...
Terms matched: 1  -  Score: 94  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
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