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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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

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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

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.

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1. FA-11E.pdf
... Web Portal. Questions? Call: (800) 525-2395 Request Date: REQUEST TYPE: Initial Prior Authorization For initial requests please also attach the ASD Diagnosis Certification ...
Terms matched: 1  -  Score: 26  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf
2. FA-11E-I.pdf
... €¢ Enter the date the request is created and submitted via EVS. Request Type: • Initial Prior Authorization: o Check this box if the ...
Terms matched: 1  -  Score: 23  -  02 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11E-I.pdf
3. Claims_Appeals_Tip_Sheet.pdf
... the Billing Manual? Contact Information The Billing Manual for all General Inquiries: provider types is available Gainwell Technologies Contact Center online on the 877-638-3472 Provider Billing Information Monday ...
Terms matched: 1  -  Score: 20  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Claims_Appeals_Tip_Sheet.pdf
4. Known_Issues.pdf
... 188 Claims, Claims submitted by provider types 24-(Advanced • ... PCS) on the Web Portal. 36 Claims, PCS Some claims may be ...
Terms matched: 2  -  Score: 379  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
5. web_announcement_3774_20251119.pdf
... November 19, 2025 Nevada Medicaid Web Announcement 3774 Attention Provider Type 17 (Special Clinics) Specialty 181 (Federally Qualified Health Center): Revision to Web ...
Terms matched: 1  -  Score: 52  -  26 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3774_20251119.pdf
6. New_Provider_Road_Map.pdf
... Flex will be shown. Attend one of these monthly sessions for all New provider types for a general overview of the Provider Nevada Medicaid program including website Orientation navigations ...
Terms matched: 1  -  Score: 73  -  21 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/New_Provider_Road_Map.pdf
7. web_announcement_3735_20251002.pdf
... Billing for Dental Encounters October 2, 2025 Nevada Medicaid Web Announcement 3735 Attention Provider Type 17 (Special Clinics) Specialty 181 (Federally Qualified Health Center): ...
Terms matched: 1  -  Score: 41  -  19 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3735_20251002.pdf
8. NV_BillingGuidelines_PT43.pdf
... Provider Type 43 Billing Guide Laboratory, Pathology Clinical Clinical laboratory tests are furnished primarily in three distinct settings: physician office laboratories, hospital-based laboratories, and independent ...
Terms matched: 1  -  Score: 273  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43.pdf
9. NV_BillingGuidelines_PT43_20250804.pdf
... Provider Type 43 Billing Guide Laboratory, Pathology Clinical Clinical laboratory tests are furnished primarily in three distinct settings: physician office laboratories, hospital-based laboratories, and independent ...
Terms matched: 1  -  Score: 273  -  18 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20250804.pdf
10. web_announcement_3766_20251112.pdf
... November 12, 2025 Nevada Medicaid Web Announcement 3766 Attention Provider Type 10 (Outpatient Surgery, Hospital Based): Reminder of Prior Authorization Requirement for Procedure Code ...
Terms matched: 1  -  Score: 42  -  12 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3766_20251112.pdf
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