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]

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NOTIFICATION: The Provider Pre-Admission Screening Resident Review (PASRR) service will be unavailable from 8 p.m. to midnight Pacific Time on Monday, January 12, 2026, for scheduled maintenance.

EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
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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.

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1. NV_BillingGuidelines_PT22-attachmentB.pdf
... (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation Contraindicated any provider, within 91 days. D7241 and 00 D7261 are contraindicated ...
Terms matched: 1  -  Score: 12  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
2. NV_BillingGuidelines_PT60.pdf
... apical closure/calcific repair or • Once in a lifetime per tooth perforations, root resorption, etc.) . D3352 Apexification/recalcification †...
Terms matched: 1  -  Score: 21  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
3. NV_BillingGuidelines_PT60_2024-0828.pdf
... apical closure/calcific repair or • Once in a lifetime per tooth perforations, root resorption, etc.) . D3352 Apexification/recalcification †...
Terms matched: 1  -  Score: 21  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
4. NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation Contraindicated any provider, within 91 days. D7241 and 00 D7261 are contraindicated ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
5. NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation Contraindicated any provider, within 91 days. D7241 and 00 D7261 are contraindicated ...
Terms matched: 1  -  Score: 12  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
6. 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
7. Immunomodulators_2018-0910.pdf
... ) o Diarrhea, nausea, and vomiting with Otezla (apremilast) o Gastrointestinal perforations with Xeljanz / Xeljanz XR (tofacitinib) o Consult prescribing information for other ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-0910.pdf
8. Immunomodulators_2018-09.pdf
... ) o Diarrhea, nausea, and vomiting with Otezla (apremilast) o Gastrointestinal perforations with Xeljanz / Xeljanz XR (tofacitinib) o Consult prescribing information for other ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-09.pdf
9. Immunomodulators_2015-0930.pdf
... receiving immunosuppressive agents including tocilizumab for rheumatoid arthritis. Additionally, viral reactivation, gastrointestinal perforations, and increased lipid levels were reported with tocilizumab. The impact of tocilizumab ...
Terms matched: 1  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2015-0930.pdf
10. Immunomodulators_2015-0812.pdf
... receiving immunosuppressive agents including tocilizumab for rheumatoid arthritis. Additionally, viral reactivation, gastrointestinal perforations, and increased lipid levels were reported with tocilizumab. The impact of tocilizumab ...
Terms matched: 1  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2015-0812.pdf
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