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 September 2026 Professional Claims. See Web Announcement 4031.

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_Billing_General.pdf
... of Durable Medical Equipment, Prosthetics, Orthotics and Disposable Medical Supplies (DMEPOS) suppliers who must revalidate every three (3 ) years per 42 CFR 424.57. ...
Terms matched: 1  -  Score: 25  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
2. NV_Billing_General_20261008.pdf
... of Durable Medical Equipment, Prosthetics, Orthotics and Disposable Medical Supplies (DMEPOS) suppliers who must revalidate every three (3 ) years per 42 CFR 424.57. ...
Terms matched: 1  -  Score: 24  -  22 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20261008.pdf
3. NV_BillingGuidelines_PT32_Spec_249.pdf
... timelines outlined in the Billing Manual. Code Service Limit 87635 2 units allowed per rolling month - PA Override 87636 2 units allowed per rolling month - PA Override ...
Terms matched: 1  -  Score: 134  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_249.pdf
4. NV_BillingGuidelines_PT32_Spec_249_online_20260727.pdf
... COVID-19 Testing Nevada Medicaid covers COVID-19 diagnostic and serology antibody testing up to twice per rolling month for each recipient. If additional testing is deemed medically necessary, a ...
Terms matched: 1  -  Score: 20  -  21 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_Spec_249_online_20260727.pdf
5. Provider_Enrollment_Information_Booklet.pdf
... of Pharmacy License o as a Medical Device, Equipment and Gases (MDEG) Supplier OR o as a Pharmacy (Exception to MDEG licensure: A Pharmacy that ...
Terms matched: 1  -  Score: 11  -  19 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. NV_Billing_General_20260710.pdf
... of Durable Medical Equipment, Prosthetics, Orthotics and Disposable Medical Supplies (DMEPOS) suppliers who must revalidate every three (3 ) years per 42 CFR 424.57. ...
Terms matched: 1  -  Score: 24  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... : Do not use this provider/supplier primary identifier. code for claims attachment ... CO) 5500 1 UNIT ALLOWED PER ROLLING YEAR 5500 ONE UNIT ALLOWED PER ROLLING ...
Terms matched: 2  -  Score: 448  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. web_announcement_4023_20261001.pdf
... Residential Treatment Facilities): Age Correction for Complex Case Criteria Correction to Web Announcement 3970: The special rate for private psychiatric residential treatment facilities (PRTF) for ...
Terms matched: 1  -  Score: 38  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4023_20261001.pdf
9. web_announcement_3970_20260722.pdf
... July 22, 2026 (Updated October 1, 2026) Nevada Medicaid Web Announcement 3970 Attention Provider Type 63 (Psychiatric Residential Treatment Facility (PRTF)): ...
Terms matched: 1  -  Score: 38  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3970_20260722.pdf
10. NV_BillingGuidelines_PT14_online_092126.pdf
... per day for the next 90 days; based on a Authorization individual services can rolling calendar and consecutive months requests above be billed without the with no break in ...
Terms matched: 1  -  Score: 37  -  29 Sep 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_092126.pdf
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