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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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. Error_Code_to_EOB_to_ANSI.pdf
... loop 2110 indicator. Service Payment Information REF), if present. 4105 NO FLAT FEE ON FILE 139 No Flat Fee on File. 16 Claim/service ...
Terms matched: 1  -  Score: 21  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Known_Issues.pdf
... 2019 9/12/2019 Institutional incorrectly with error code 4105-(no flat fee on • Once resolved, claims will be Claims file) ...
Terms matched: 1  -  Score: 11  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. web_announcement_3684_20250728.pdf
... the proposed change, the existing reimbursement methodology would be amended to a $944 flat per diem rate for private hospitals. The proposed effective date for the SPA ...
Terms matched: 1  -  Score: 23  -  28 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3684_20250728.pdf
4. web_announcement_3640_20250521.pdf
... change, the existing reimbursement methodology would be amended to change the reimbursement to a flat rate of $800 with the possibility of a $150 add-on option for ...
Terms matched: 1  -  Score: 23  -  21 May 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3640_20250521.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. Encounter-Professional_837P_MCO_Companion_Guide_-_Mod.pdf
... MCOs could use either of these to populate Prior Authorization and/or capitation/flat/value additions instead of CN1 segment. There are two parts under REF02 ...
Terms matched: 1  -  Score: 67  -  06 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Professional_837P_MCO_Companion_Guide_-_Mod.pdf
7. Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
... MCOs could use either of these to populate Prior Authorization and/or capitation/flat/value additions instead of CN1 segment. There are two parts under REF02 ...
Terms matched: 1  -  Score: 57  -  06 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
8. Encounter-Dental_837D_MCO_Companion_Guide_-_Mod.pdf
... MCOs could use either of these to populate Prior Authorization and/or capitation/flat/value additions instead of CN1 segment. There are two parts under REF02 ...
Terms matched: 1  -  Score: 32  -  06 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Dental_837D_MCO_Companion_Guide_-_Mod.pdf
9. Incretin_Mimetics_2014_0811.pdf
... are superior to neutral protamine Hagedorn (NPH) insulin because they provide a fairly flat response for approximately 24 hours and provide better reproducibility and consistency, both between ...
Terms matched: 1  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Incretin_Mimetics_2014_0811.pdf
10. Incretin_Mimetics_2013-1031.pdf
... are superior to neutral protamine Hagedorn (NPH) insulin because they provide a fairly flat response for approximately 24 hours and provide better reproducibility and consistency, both between ...
Terms matched: 1  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Incretin_Mimetics_2013-1031.pdf
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