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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

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
... 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  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT17_Specialty_181_20260102.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  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
3. 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: 21  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
4. ABA_FAQ.pdf
... the FA-11F form. This is to be signed by the diagnosing physician that is ordering the services (must be a Physician, Physician’s Assistant, ...
Terms matched: 1  -  Score: 20  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
5. Provider_Enrollment_Information_Booklet.pdf
... To bill for services rendered or to order, prescribe, and refer services to ... & • Medicare Certification for Portable/Mobile X-ray (if 27 927 ...
Terms matched: 2  -  Score: 154  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. FA-1D.pdf
... to substantiate payment by Medicaid per PT 33 fee schedule, and an unaltered complete order form specific to the manufacturer and model of the items being requested must be ...
Terms matched: 1  -  Score: 26  -  23 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-1D.pdf
7. NV_Billing_General_20260101.pdf
... . Providers who are enrolled as an Ordering, Prescribing or Referring (OPR) ... or Abuse .... 5 Health Insurance Portability and Accountability Act (HIPAA) ... ...
Terms matched: 2  -  Score: 76  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
8. NV_Billing_General.pdf
... . Providers who are enrolled as an Ordering, Prescribing or Referring (OPR) ... Fraud or Abuse.... 5 Health Insurance Portability and Accountability Act (HIPAA) ... ...
Terms matched: 2  -  Score: 76  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
9. NV_EVS_User_Manual_Ch1.pdf
... must then add their information as a delegate and then register as a delegate in order to utilize the secure features in PWP. The website uses data from your ...
Terms matched: 1  -  Score: 38  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
10. 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  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
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