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
... providers, regardless of provider type (PT), ... days to ten days; 22 and 23 updated instructions ... who do not revalidate within 60 days of the date ...
Terms matched: 3  -  Score: 283  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
2. NV_Billing_General_20260710.pdf
... providers, regardless of provider type (PT), ... days to ten days; 22 and 23 updated instructions ... who do not revalidate within 60 days of the date ...
Terms matched: 3  -  Score: 283  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260710.pdf
3. Team_Territories.pdf
... to providers based on provider type. Please refer to ... Codes: • 22 â€" Dentist ... Services) • 60 â€" School ...
Terms matched: 3  -  Score: 198  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Team_Territories.pdf
4. web_announcement_4026_20261008.pdf
... (Community Residential Mental Health Services (CRMHS)) To Be Created Under Provider Type 63 (Rehabilitative Residential Treatment Services) Nevada Medicaid is creating a new specialty ...
Terms matched: 1  -  Score: 74  -  08 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4026_20261008.pdf
5. Error_Code_to_EOB_to_ANSI.pdf
... , if present. 273 TYPE OF BILL MISSING 4100 ... /06/2026 Page 22 of 162 Claim Error ... EOB/ANSI Code Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE ...
Terms matched: 3  -  Score: 1085  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. web_announcement_4025_20261006.pdf
... claims for long-acting reversible contraception (LARC) device services may be billed by provider type (PT) 12 (Hospital, Outpatient) or 96 (Rural Emergency ...
Terms matched: 1  -  Score: 44  -  06 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4025_20261006.pdf
7. web_announcement_4023_20261001.pdf
... Complex Case Criteria Correction to Web Announcement 3970: The special rate for private psychiatric ... Nevada Medicaid Web Announcement 4023 Attention Provider Type 63 (Psychiatric Residential Treatment Facilities) ...
Terms matched: 2  -  Score: 55  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4023_20261001.pdf
8. web_announcement_3970_20260722.pdf
... ) Nevada Medicaid Web Announcement 3970 Attention Provider Type 63 ... Psychiatric Residential Treatment Facility (PRTF)): Rate ... July 22, 2026 (Updated October 1, ...
Terms matched: 3  -  Score: 191  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3970_20260722.pdf
9. FA-15.pdf
... this form, call: (800) 525-2395 REQUEST DATE: / / REQUEST TYPE: Initial Review Concurrent Review Retrospective Authorization â€" Date of Eligibility Decision ...
Terms matched: 1  -  Score: 47  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-15.pdf
10. NV_Billing_Sterilization.pdf
... hysterectomy, for uterus 250 grams or less; with copo-urethocystopexy (Marshall-Marchette- Krantz type, Pereyra type) with or without endoscopic control 58270 Vaginal hysterectomy, for ...
Terms matched: 1  -  Score: 44  -  01 Oct 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Sterilization.pdf
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