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: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time on Sunday, March 22, 2026, for scheduled maintenance:
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    • Gainwell Technologies Contact Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
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Known System Issues-Click HERE

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 https://NevadaMedicaid.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
... : 03/09/2026 Page 20 of 180 Claim Error/EOB/ ... Information REF), if present. 400 DETAIL UNITS OF SERVICE MUST BE 1830 ...
Terms matched: 2  -  Score: 91  -  09 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. NV_BillingGuidelines_PT17_Spec181.pdf
... Program: contains important information applicable to all provider types • MSM Chapter 400 â€" Mental Health and Alcohol and Substance Abuse Services • ...
Terms matched: 1  -  Score: 23  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
3. NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... Program: contains important information applicable to all provider types • MSM Chapter 400 â€" Mental Health and Alcohol and Substance Abuse Services • ...
Terms matched: 1  -  Score: 23  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
4. ABA_FAQ.pdf
... for supervision? The maximum number of units that can be used for supervision is 20% of the total number of hours of direct therapy services provided. Is ...
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
... . 16 Out-of-State Catchment Providers .... 20 Table 4: Nevada Medicaid Catchment Areas ... Health Outpatient Treatment Group • 400*: Ordering, Prescribing, Referring ...
Terms matched: 2  -  Score: 383  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
6. NV_Billing_General.pdf
... Up AND NEVADA CHECK UP Updated February 20, 2026 Change history Date (mm ... : Hospital Services 300: Radiology Services 400: Mental Health Services 500: Nursing ...
Terms matched: 2  -  Score: 257  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_Billing_General_20260101.pdf
... ; and ICD-10 effective date 02/20/2015 Added DMEPOS to prior authorization ... : Hospital Services 300: Radiology Services 400: Mental Health Services 500: Nursing ...
Terms matched: 2  -  Score: 78  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
8. NV_EVS_User_Manual_Ch1.pdf
... and Password. 7 6 8 • The password must be 8 to 20 characters in length, not be the same as your User ID or contain ...
Terms matched: 1  -  Score: 63  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
9. NV_Flex_User_Guide_Getting_Started.pdf
... select “Continueâ€. • The password must be 8 to 20 characters in length, cannot be the same as your User ID or contain ...
Terms matched: 1  -  Score: 37  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
10. NV_BillingGuidelines_PT85_Spec320.pdf
... covers policy for Applied Behavior Analysis (ABA) providers • MSM Chapter 400 covers policy for Behavioral Health providers • MSM Chapter 100 contains important ...
Terms matched: 1  -  Score: 21  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
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