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]

Notifications

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

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.

Scheduled Site Maintenance

During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... molars D1353 Sealant repair - per tooth 00 1 unit per 36 months D1354 Interim caries arresting medicament application per 1 service unit per 6 months per tooth 00 tooth ...
Terms matched: 1  -  Score: 14  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... molars D1353 Sealant repair - per tooth 00 1 unit per 36 months D1354 Interim caries arresting medicament application per 1 service unit per 6 months per tooth 00 tooth ...
Terms matched: 1  -  Score: 14  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.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
... RESTORATION IN A 00 NC NC Once in a lifetime per tooth MODERATE TO HIGH CARIES RISK PATIENT - PERMANENT TOOTH D1353 SEALANT REPAIR - PER TOOTH 00 NC NC ...
Terms matched: 1  -  Score: 38  -  15 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
... outcomes are desirable. ï ‚ In a meta-analysis of 41 RCTs that used hierarchical clustering to rate efficacy and tolerability, Humira (adalimumab), Cosentyx (secukinumab ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-0910.pdf
... outcomes are desirable. ï ‚ In a meta-analysis of 41 RCTs that used hierarchical clustering to rate efficacy and tolerability, Humira (adalimumab), Cosentyx (secukinumab ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-09.pdf
... outcomes are desirable. ï ‚ In a meta-analysis of 41 RCTs that used hierarchical clustering to rate efficacy and tolerability, HUMIRA (adalimumab), COSENTYX (secukinumab ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-1228.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
... 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
... Tongue discoloration - - - - - Tongue swollen - - - a - Tooth caries/ - 0.1 to 1.0 3 to 4 - >2 toothache Tooth infection ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ER%20Injectable%20Atypical%20Antipsychotics.pdf
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