Nevada Medicaid and Nevada Check Up News (Fourth 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: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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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. Provider_Enrollment_Information_Booklet.pdf
... ¢ 930: Personal Care Services - Provider Agency (EVV Required) Ambulance, Air or Ground Specialty type code: 32 • 249: Community Paramedicine ...
Terms matched: 1  -  Score: 34  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
2. Known_Issues.pdf
... Applicable) 64 Claims, Provider Some claims for Provider Type 32-(Ambulance Air • Provider: No additional action needed. 1/14/ ...
Terms matched: 1  -  Score: 49  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. Team_Territories.pdf
... ¢ 21 â€" Podiatrist • 32 â€" Ambulance, Air or Ground • 34 â€" Therapy • 35 ...
Terms matched: 1  -  Score: 21  -  06 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Team_Territories.pdf
4. NV_BillingGuidelines_PT34_2023-1121.pdf
... 94010, with administered agents (e.g., antigen[s ], cold air, methacholine) Updated 11/21/2023 Provider Type 34 Billing Guide ...
Terms matched: 1  -  Score: 12  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
5. NV_BillingGuidelines_PT34.pdf
... 94010, with administered agents (e.g., antigen[s ], cold air, methacholine) Updated 01/01/2026 Provider Type 34 Billing Guide ...
Terms matched: 1  -  Score: 12  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
6. NV_BillingGuidelines_PT60.pdf
... • Limit 1 unit per day 92551 Screening test, pure tone, air only. • Encounter = 1 unit Includes testing of both ears ...
Terms matched: 1  -  Score: 12  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. NV_BillingGuidelines_PT60_2024-0828.pdf
... • Limit 1 unit per day 92551 Screening test, pure tone, air only. • Encounter = 1 unit Includes testing of both ears ...
Terms matched: 1  -  Score: 12  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
8. NV_BillingGuidelines_PT33_20250623.pdf
... corner chairs Household items, such as but not limited to: • Air conditioners (includes swamp coolers) • Appliances (microwave, cutting ...
Terms matched: 1  -  Score: 24  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
9. NV_BillingGuidelines_PT33.pdf
... corner chairs Household items, such as but not limited to: • Air conditioners (includes swamp coolers) • Appliances (microwave, cutting ...
Terms matched: 1  -  Score: 24  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
10. NV_Flex_User_Guide_Individual.pdf
... œEFT Enrollmentâ€section will not display for individual provider types 32 (Ambulance, Air or Ground) and 89 (Community Health Worker) or for individuals with ...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
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