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
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Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

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Top 10 Claim Denial Reasons and Resolutions/Workarounds for November 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. Benefit_Enrollment_and_Maintenance_(834).pdf
... Number Qualifiers: AP, BN, CP, EM, EX, FX, HP, TE, WP. 160 2310 PER04 Communication Number 10 162 2310 PLA ...
Terms matched: 1  -  Score: 11  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
2. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
3. Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
... 4 Revenue Code 425 2400 SV202-1 Product/Service ID ER, HC, 2 HP, IV, WK 426 2400 SV202-2 Procedure Code 426 2400 SV202-3 to Procedure ...
Terms matched: 1  -  Score: 11  -  06 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Institutional_837I_MCO_Companion_Guide_-_Mod.pdf
4. ICD-10_Testing_Schedule.pdf
... who have questions regarding the test effort or who may be interested in testing with HP Enterprise Services (HPES) can send an email to the ICD- 10 ...
Terms matched: 1  -  Score: 23  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_Testing_Schedule.pdf
5. ICD-10_Testing_Instructions.pdf
... Check Up ICD-10 Testing Instructions The first step in the ICD-10 testing process is for HP Enterprise Services (HPES) to create a base of ICD-9 claims for trading ...
Terms matched: 1  -  Score: 26  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_Testing_Instructions.pdf
6. ICD-10_FAQs.pdf
... the mandated date. Testing will ensure readiness for all parties (trading partners and HP Enterprise Services - HPES) and will reduce the impact of this implementation for ...
Terms matched: 1  -  Score: 23  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ICD-10_FAQs.pdf
7. HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
... JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, ... . 100. Furberg CD, Adams HP, Applegate WB, Byington RP, ...
Terms matched: 2  -  Score: 31  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG_CoA_Reductase_Inhibitors_2013-0812.pdf
8. HMG CoA Reductase Inhibitors.pdf
... JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, ... . 100. Furberg CD, Adams HP, Applegate WB, Byington RP, ...
Terms matched: 2  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/HMG%20CoA%20Reductase%20Inhibitors.pdf
9. Health_Care_Payment_Advice_(835)_n062818.pdf
... /Comments Page # ID C.7 GS Functional Group Header C.7 GS01 Functional ID Code HP 2 C.7 GS02 Application Sender’s NVMED 5 NV Medicaid Trading Partner ...
Terms matched: 1  -  Score: 22  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Payment_Advice_(835)_n062818.pdf
10. Health_Care_Claim_Status_Inquiry_and_Response_(276-277)_n062818.pdf
... Line Information 157 2220D SVC01-1 Product Service ID AD, ER, Qualifier HC, HP, IV, N4, NU, WK American Dental AD 2 Association Code ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Claim_Status_Inquiry_and_Response_(276-277)_n062818.pdf
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