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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 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. web_announcement_3757_20251103.pdf
... Fazaclo removed from the PDL due to product discontinuation Topical Antivirals • Xerese cream, Zovirax cream, and Zovirax ointment removed from the PDL due to these ...
Terms matched: 1  -  Score: 54  -  03 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3757_20251103.pdf
2. web_announcement_3685_20250801.pdf
... class added to the PDL • Preferred agents to include: o hydrocortisone cream (topical and rectal), oint o hydrocortisone acetate cream, oint o ...
Terms matched: 1  -  Score: 179  -  01 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3685_20250801.pdf
3. web_announcement_3598_20250403.pdf
... to product discontinuation • Ebglyss®, Nemluvio®, and Zoryve® cream added to PDL as non-preferred Opiate Agonists: Abuse Deterrents • Xtampza ...
Terms matched: 1  -  Score: 20  -  03 Apr 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3598_20250403.pdf
4. 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
5. NV_BillingGuidelines_PT21_20180627.pdf
... coverage for preventive care including the cleaning and soaking of feet, the application of creams to ensure skin tone and routine foot care. Routine foot care includes the ...
Terms matched: 1  -  Score: 20  -  29 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT21_20180627.pdf
6. NV_BillingGuidelines_PT21.pdf
... coverage for preventive care including the cleaning and soaking of feet, the application of creams to ensure skin tone and routine foot care. Routine foot care includes the ...
Terms matched: 1  -  Score: 20  -  29 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT21.pdf
7. HMG CoA Reductase Inhibitors.pdf
... 3 ): 427-37. 104. Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, et al. Effect ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG%20CoA%20Reductase%20Inhibitors.pdf
8. HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
... 3 ): 427-37. 104. Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, et al. Effect ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
9. Exondys_51_2017-0314.pdf
... Infuse over 35 to 60 minutes; (eteplirsen) application of a topical anesthetic cream to the infusion site prior to administration may be considered (EXONDYS 51 Prescribing ...
Terms matched: 1  -  Score: 24  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Exondys_51_2017-0314.pdf
10. Encounter NCPDP Companion Guide - Mod n061818.pdf
... preparation, used as a vehicle for medication and applied externally to the body 03 Cream- a soft solid or thick liquid containing medication, applied externally for a ...
Terms matched: 1  -  Score: 10  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter%20NCPDP%20Companion%20Guide%20-%20Mod%20n061818.pdf
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