Nevada Medicaid and Nevada Check Up News (Third 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 November 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. 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  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_Enrollment_AnnualAttestation_PT63.pdf
... CFR 483.374(c ) requires: “In addition to the reporting requirements contained in paragraph (b ) of this section, facilities must report the death ...
Terms matched: 1  -  Score: 21  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Enrollment_AnnualAttestation_PT63.pdf
3. FA-11E.pdf
... benefits and other terms and conditions set forth by the benefit program. The information contained in this form, including attachments, is privileged and confidential and is only ...
Terms matched: 1  -  Score: 20  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
4. 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  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
5. NV_BillingGuidelines_PT43.pdf
... ) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter 600 ...
Terms matched: 1  -  Score: 26  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
6. NV_BillingGuidelines_PT43_20250804.pdf
... ) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter 600 ...
Terms matched: 1  -  Score: 26  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
7. 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  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
8. NV_Flex_User_Guide_Group.pdf
... certain questions. Days and Hours of Operation The Day and Hours of Operation section contains From and To time fields for entering service hours. Service hours can be ...
Terms matched: 1  -  Score: 24  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
9. NV_Flex_User_Guide_Individual.pdf
... red asterisk. Days and Hours of Operation The Days and Hours of Operation section contains From and To time fields for entering service hours. Service hours can be ...
Terms matched: 1  -  Score: 24  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
10. Benefit_Enrollment_and_Maintenance_(834).pdf
... the errata document identifier. The information contained in this companion guide is subject to ... EN = English RU, SO, ES, TL, VI FR = French ...
Terms matched: 2  -  Score: 228  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
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