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.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

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. Known_Issues.pdf
... /5 /2019 2/18/2019 N/A Submission, that contains other insurance information, as the o Option 1: Enter a new claim ...
Terms matched: 1  -  Score: 14  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_BillingGuidelines_PT17_Spec188.pdf
... Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains important information applicable to all provider types. Authorization Requirements All services must be ...
Terms matched: 1  -  Score: 21  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
3. NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains important information applicable to all provider types. Authorization Requirements All services must be ...
Terms matched: 1  -  Score: 21  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... Check Up programs. State Policy Nevada Medicaid determines state policy. This policy is contained in the Medicaid Services Manual (MSM), which is also published on ...
Terms matched: 1  -  Score: 28  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. NV_BillingGuidelines_PT14_online_030525.pdf
... Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed online ...
Terms matched: 1  -  Score: 31  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
6. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... time requirement for 99492 or 99493.Dermatology services For some dermatology services, the CPT descriptors contain language, such as additional lesion, to indicate that multiple surgical procedures have ...
Terms matched: 1  -  Score: 29  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
7. NV_BillingGuidelines_PT20-24-77.pdf
... for 99492 or 99493. Dermatology services For some dermatology services, the CPT descriptors contain language, such as additional lesion, to indicate that multiple surgical procedures have ...
Terms matched: 1  -  Score: 29  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
8. NV_BillingGuidelines_PT14.pdf
... Chapter 400 covers policy for behavioral health providers. • MSM Chapter 100 contains important information applicable to all provider types. Rates Reimbursement rates are listed online ...
Terms matched: 1  -  Score: 28  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
9. Error_Code_to_EOB_to_ANSI.pdf
... replacement claim BE ADJUSTED manually priced or contained a PAD detail. submission/billing ... RSTCN FOR REV BILL 1581 Diagnos(es) not allowable for the billed 96 ...
Terms matched: 2  -  Score: 62  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
10. NV_BillingGuidelines_PT17_Spec181.pdf
... /dhcfp.nv.gov. • MSM Chapter 100 â€" Medicaid Program: contains important information applicable to all provider types • MSM Chapter 400 â ...
Terms matched: 1  -  Score: 23  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
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