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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... ) D0120 Periodic oral examination - Patient of Record 00 1 service unit per 6 rolling months D0150 Comprehensive oral examination - New Patient 00 1 service unit per 12 ...
Terms matched: 1  -  Score: 151  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
... ) D0120 Periodic oral examination - Patient of Record 00 1 service unit per 6 rolling months D0150 Comprehensive oral examination - New Patient 00 1 service unit per 12 ...
Terms matched: 1  -  Score: 151  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... shows how to bill continued services (rolling months) for code B4035 (a ... (DMEPOS) • Power door openers • Ramps or wheelchair ...
Terms matched: 2  -  Score: 75  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
... shows how to bill continued services (rolling months) for code B4035 (a ... lifts for vehicle • Power door openers • Ramps or wheelchair ...
Terms matched: 2  -  Score: 75  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
... OA except where state workers compensation regulations requires CO) 5500 1 UNIT ALLOWED PER ROLLING YEAR 5500 ONE UNIT ALLOWED PER ROLLING YEAR 119 Benefit maximum for this time ...
Terms matched: 1  -  Score: 337  -  09 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
... ) D0120 Periodic oral examination - Patient of Record 00 1 service unit per 6 rolling months D0150 Comprehensive oral examination - New Patient 00 1 service unit per 12 ...
Terms matched: 1  -  Score: 151  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... (Dental automatically reprocessed. 4/1 /2019 Services Not Allowed within Six Rolling Months) . Bitewing Images Procedure Codes: • D0270-( ...
Terms matched: 1  -  Score: 124  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
... every 30 days. Only three definitive drug tests are permitted per recipient per 12 rolling months prior to a PA being required. Standing orders are not permitted for ...
Terms matched: 1  -  Score: 39  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
... every 30 days. Only three definitive drug tests are permitted per recipient per 12 rolling months prior to a PA being required. Standing orders are not permitted for ...
Terms matched: 1  -  Score: 39  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
... ) . PA can be submitted to exceed the service limitation of 60 units per rolling month. PT 33 providers must submit an invoice for these services. See ...
Terms matched: 1  -  Score: 37  -  12 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3765_20251112.pdf
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