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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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 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. Known_Issues.pdf
... ) and/or error code 1022-(Referring NPI required) when the ordering NPI is entered appropriately with the “DKâ€qualifier. 84 Claims ...
Terms matched: 1  -  Score: 47  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
2. NV_BillingGuidelines_PT17_Spec188.pdf
... Payment System (PPS) rate that is specific to each individual CCBHC. In order to identify the nature of the services rendered, the CCBHC must submit each ...
Terms matched: 1  -  Score: 20  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
3. NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... Payment System (PPS) rate that is specific to each individual CCBHC. In order to identify the nature of the services rendered, the CCBHC must submit each ...
Terms matched: 1  -  Score: 20  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
4. Provider_Enrollment_Information_Booklet.pdf
... Nevada Medicaid and Nevada Check Up programs. To bill for services rendered or to order, prescribe, and refer services to Nevada Medicaid recipients (hereafter referred to ...
Terms matched: 1  -  Score: 211  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
5. NV_BillingGuidelines_PT26_20251013.pdf
... : Psychological Intern • 248: Psychological Trainee • 400: Ordering, Prescribing, Referring (OPR) Smoking/Tobacco Cessation Counseling Effective on ...
Terms matched: 1  -  Score: 23  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20251013.pdf
6. NV_BillingGuidelines_PT26.pdf
... : Psychological Intern • 248: Psychological Trainee • 400: Ordering, Prescribing, Referring (OPR) Smoking/Tobacco Cessation Counseling Effective on ...
Terms matched: 1  -  Score: 23  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26.pdf
7. Error_Code_to_EOB_to_ANSI.pdf
... Identification Segment (loop 2110 Service Payment Information REF), if present. 1062 ORDERING NPI REQUIRED 1062 Ordering NPI is required. 16 Claim/service lacks information ...
Terms matched: 1  -  Score: 150  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
8. NV_BillingGuidelines_PT17_Spec181.pdf
... is identified by billing one unit of the valid encounter code listed below. In order to identify the nature of the services rendered, the FQHC must also submit ...
Terms matched: 1  -  Score: 23  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
9. NV_BillingGuidelines_PT34.pdf
... therapy services furnished in whole or in part by a physical therapist assistant) . Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 116  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
10. NV_BillingGuidelines_PT34_2023-1121.pdf
... therapy services furnished in whole or in part by a physical therapist assistant) . Ordering, Prescribing or Referring (OPR) Provider Requirements The Patient Protection and Affordable ...
Terms matched: 1  -  Score: 116  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
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