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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
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URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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. NV_BillingGuidelines_PT22-attachmentA.pdf
... per 60 months D9210 DENT ANESTHESIA W/O SURGERY 00 00 00 D9212 TRIGEMINAL BLOCK ANESTHESIA 00 00 00 D9215 LOCAL ANESTHESIA 00 00 00 D9222 DEEP SEDAT/ ...
Terms matched: 1  -  Score: 12  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. NV_BillingGuidelines_PT60.pdf
... D9210 Local anesthesia not in conjunction with operative or surgical procedures. D9212 Trigeminal division block anesthesia. D9215 Local anesthesia in conjunction with operative or surgical procedures. D9222 ...
Terms matched: 1  -  Score: 10  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
3. NV_BillingGuidelines_PT60_2024-0828.pdf
... D9210 Local anesthesia not in conjunction with operative or surgical procedures. D9212 Trigeminal division block anesthesia. D9215 Local anesthesia in conjunction with operative or surgical procedures. D9222 ...
Terms matched: 1  -  Score: 10  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
4. web_announcement_3731_20250926.pdf
... , 2025, the First Circuit Court of Appeals removed the previous preliminary injunctions that blocked immediate implementation of this section. Therefore, Nevada Medicaid issues the following guidance ...
Terms matched: 1  -  Score: 23  -  26 Sep 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3731_20250926.pdf
5. 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
6. Inhaled Antimuscarinics 2012 12.pdf
... - - - ï increased Elevated heart rate - - - ï First degree atrioventricular block <1 - - - Heart failure <1 - - - Hypertension - ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Antimuscarinics%202012%2012.pdf
7. Inhaled Anticholinergics.pdf
... - First degree - - <1 - - - - - - - atrioventricular block Heart failure <1 - - - - - - - - - Hypertension ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Anticholinergics.pdf
8. Ingrezza_2017-0918.pdf
... TD) is an iatrogenic condition that results from the long-term use of dopamine receptor blocking agents (DRBAs), predominantly antipsychotics/neuroleptics (first generation antipsychotics [ ...
Terms matched: 1  -  Score: 16  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Ingrezza_2017-0918.pdf
9. Immunomodulators_2018-0910.pdf
... more DMARDs. Can be used alone or in combination with DMARDs other than TNF blocking agents. â žâ žIndicated for reducing signs and symptoms, inducing major clinical ...
Terms matched: 1  -  Score: 14  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-0910.pdf
10. Immunomodulators_2018-09.pdf
... more DMARDs. Can be used alone or in combination with DMARDs other than TNF blocking agents. â žâ žIndicated for reducing signs and symptoms, inducing major clinical ...
Terms matched: 1  -  Score: 14  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-09.pdf
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