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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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.

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.
Email: nvmmis.edisupport
@gainwelltechnologies.com
Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

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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1. Error_Code_to_EOB_to_ANSI.pdf
... Inpatient and Inpatient Crossover claims without an attachment that post this edit will pay and cut back one unit with EOB 0383. Inpatient/Inpatient Crossover claims with attachments ...
Terms matched: 1  -  Score: 112  -  10 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Known_Issues.pdf
... 06/2023 02/21/2023 NA Inpatient) are being denied or cut back needed. inappropriately with error codes 5643-(3 Units †...
Terms matched: 1  -  Score: 11  -  04 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
4. NV_BillingGuidelines_PT22-attachmentB.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 Updated 02/02/2026 pv ...
Terms matched: 1  -  Score: 12  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
5. NV_BillingGuidelines_PT22-attachmentA.pdf
... EXCISN OF JOINT MEMBRANE 00 NC 00 D7858 TMJ RECONSTRUCTION 01 NC 01 D7860 TMJ CUTTING INTO JOINT 00 NC 00 D7865 TMJ RESHAPING COMPONENTS 00 NC 00 D7870 TMJ ...
Terms matched: 1  -  Score: 49  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
6. NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
7. NV_BillingGuidelines_PT33_20250623.pdf
... ¢ Air conditioners (includes swamp coolers) • Appliances (microwave, cutting boards or other adaptive equipment for cooking, cleaning, etc.) â ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33_20250623.pdf
8. NV_BillingGuidelines_PT33.pdf
... ¢ Air conditioners (includes swamp coolers) • Appliances (microwave, cutting boards or other adaptive equipment for cooking, cleaning, etc.) â ...
Terms matched: 1  -  Score: 12  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT33.pdf
9. NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... days, same recipient, any provider. D7250 Removal of residual tooth roots (cutting procedure) Once in a lifetime 00 D7261 Primary closure of a sinus perforation ...
Terms matched: 1  -  Score: 12  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
10. FA-27B.pdf
... unstable and shift. This can lead to sore gums. It is best to cut your foods into small bites. If you must “take a biteâ ...
Terms matched: 1  -  Score: 20  -  16 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-27B.pdf
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