Nevada Medicaid and Nevada Check Up News (First 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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for April 2026 Professional Claims. See Web Announcement 3915.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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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1. Pregnancy_Presumptive_Eligibility_Instructions.pdf
... infectious agent antibody 81005 Urinalysis, qualitative 86592 Syphilis detection test 81007 Urinalysis, bacteriuria screen 86780 Antibody; Treponema pallidum 81015 Urinalysis, microscopic only 88230 Tissue culture, ...
Terms matched: 1  -  Score: 66  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Instructions.pdf
2. Pregnancy_Presumptive_Eligibility_Addendum.pdf
... qualified entity no longer meets the professional credential/licensing requirements, or the enrollment screening criteria described at 42 CFR 455 subpart E and Medicaid Services Manual Chapter 100 ...
Terms matched: 1  -  Score: 20  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Addendum.pdf
3. PT_34_Therapy_Tip_Sheet.pdf
... Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) ... primary care provider (if different from screening provider) - Name of the provider ...
Terms matched: 2  -  Score: 55  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
4. Known_Issues.pdf
... 11/2021 Type 32 Air or Ground) have ... ) and A7046-(water chamber for humidifier used ... . and/or Drug screening) and H2012- ...
Terms matched: 3  -  Score: 98  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
5. Error_Code_to_EOB_to_ANSI.pdf
... error(s ) . Usage: Do not use UB04 Provider Manual or Help Screens for this code for claims attachment(s )/ other valid codes. ...
Terms matched: 1  -  Score: 473  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. NV_BillingGuidelines_PT11_online_082725.pdf
... referring physicians to be enrolled in the state Medicaid program (Â 455.410 Enrollment and Screening of Providers) . The Affordable Care Act (ACA) requires physicians or ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
7. NV_BillingGuidelines_PT11.pdf
... referring physicians to be enrolled in the state Medicaid program (Â 455.410 Enrollment and Screening of Providers) . The Affordable Care Act (ACA) requires physicians or ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
8. NV_BillingGuidelines_PT60.pdf
... 92551 Screening test, pure tone, air only. • Encounter = ... . 5 Covered Services .... 5 Screening, Diagnostic and Physician Services .... ...
Terms matched: 2  -  Score: 272  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
9. NV_BillingGuidelines_PT60_2025-1216.pdf
... 92551 Screening test, pure tone, air only. • Encounter = ... Rates.... 5 Covered Services.... 5 Screening, Diagnostic and Physician Services.... 5 ...
Terms matched: 2  -  Score: 272  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
10. Provider_Enrollment_Information_Booklet.pdf
... ¢ 930: Personal Care Services - Provider Agency (EVV Required) Ambulance, Air or Ground Specialty type code: 32 • 249: Community Paramedicine ...
Terms matched: 1  -  Score: 34  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
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