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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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 2026, for scheduled maintenance:
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    • Gainwell Technologies Contact Center (877) 638-3472
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    • Known System Issues-Click HERE

    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    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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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.

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1. Known_Issues.pdf
... rule) and 4871- (Claim type restriction on proc billing table) . 100 Claims, Some Provider Type 22-(Dentist) are being †...
Terms matched: 1  -  Score: 11  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... Information REF), if present. Updated: 05/05/2026 Page 100 of 185 Claim Error/EOB/ANSI Code Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION ...
Terms matched: 1  -  Score: 30  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. web_announcement_3891_20260410.pdf
... claims, including those denied upon reprocessing. Please refer to Medicaid Services Manual Chapter 100 and the Billing Manual for information concerning the claim appeal process and time frames ...
Terms matched: 1  -  Score: 20  -  27 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3891_20260410.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... published on the following website at https://www.nevadamedicaid.nv.gov/ . MSM Chapter 100 contains specific enrollment requirements. General Information Enrollment requirements vary depending on provider type ...
Terms matched: 1  -  Score: 85  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. NV_BillingGuidelines_PT20-24-77.pdf
... endoscopy rules are applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic ...
Terms matched: 1  -  Score: 14  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77.pdf
6. NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
... endoscopy rules are applied to each series, followed by the multiple surgery rules of 100%, 50%, etc. In the case of two unrelated endoscopic ...
Terms matched: 1  -  Score: 14  -  03 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_011226_to_040326.pdf
7. NV_BillingGuidelines_PT43.pdf
... webpage) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter ...
Terms matched: 1  -  Score: 26  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
8. NV_BillingGuidelines_PT43_20251118.pdf
... webpage) . Chapters of interest to laboratories include: • MSM Chapter 100 contains important information applicable to all provider types. • MSM Chapter ...
Terms matched: 1  -  Score: 26  -  25 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20251118.pdf
9. NV_BillingGuidelines_PT22-attachmentA.pdf
... service as D7320 for the same quadrant. D7410 RAD EXC LESION UP TO 1.25 CM 00 NC NC D7411 EXCISION BENIGN LESION>1.25C 00 NC NC D7412 EXCISION ...
Terms matched: 1  -  Score: 66  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
10. NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
... service as D7320 for the same quadrant. D7410 RAD EXC LESION UP TO 1.25 CM 00 NC NC D7411 EXCISION BENIGN LESION>1.25C 00 NC NC D7412 EXCISION ...
Terms matched: 1  -  Score: 66  -  23 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA_01-29-26.pdf
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