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.
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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. NV_BillingGuidelines_PT22-attachmentA.pdf
... PROPHYLAXIS ADULT 00 02 NC 1 unit per 6 months Coverage for ages 14 - 20 D1120 DENTAL PROPHYLAXIS CHILD 00 NC NC 1 unit per 6 months Coverage for ...
Terms matched: 1  -  Score: 14  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
2. Known_Issues.pdf
... automatically re-processed. Planning) • D1206-(Topical Fluoride Varnish) 20 Claims Claims may be denying inappropriately with the • Provider: No ...
Terms matched: 1  -  Score: 230  -  27 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_EnrollmentChecklist_PT93_Spec704.pdf
... Policy Declaration I hereby declare that I have read the current MSM Chapters 100, 400, 3300 and 4100 as of the date above and understand this policy and ...
Terms matched: 1  -  Score: 20  -  24 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT93_Spec704.pdf
4. NV_BillingGuidelines_PT17_Spec188.pdf
... œResourcesâ€webpage) . MSM Chapter 2700 covers policy for CCBHCs. MSM Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains ...
Terms matched: 1  -  Score: 21  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec188.pdf
5. NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
... œResourcesâ€webpage) . MSM Chapter 2700 covers policy for CCBHCs. MSM Chapter 400 covers Mental Health and Alcohol and Substance Abuse Services. MSM Chapter 100 contains ...
Terms matched: 1  -  Score: 21  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_188_20231206.pdf
6. 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  -  23 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
7. NV_EVS_User_Manual_Ch10.pdf
... Return To Provider Letter • PRV-9020-R Provider Termination Letter • PRV-9021-R 20 Day Advance Notification of Termination • PRV-9040-R Medicaid Initial Enrollment Welcome Letter ...
Terms matched: 1  -  Score: 20  -  21 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch10.pdf
8. NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
... Provider Types 20, 24 and 77 Billing Guide Physician, M.D. and Osteopath, D.O., Advanced Practice Registered Nurses (APRN) and Physician†...
Terms matched: 1  -  Score: 339  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT20-24-77_online_101325_to_011226.pdf
9. NV_BillingGuidelines_PT14_online_030525.pdf
... or other outpatient visit for Typically, 20 minutes Physician or Requires these three key ... ) . • MSM Chapter 400 covers policy for behavioral health providers. ...
Terms matched: 2  -  Score: 120  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_030525.pdf
10. NV_BillingGuidelines_PT26_20251013.pdf
... the following three consecutive calendar months (20 units per month) . The four ... Medicaid Services Manual (MSM) Chapter 400 provides complete coverage and limitations for each ...
Terms matched: 2  -  Score: 69  -  12 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT26_20251013.pdf
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