Nevada Medicaid and Nevada Check Up News (First Quarter 2026 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 April 2026 Professional Claims. See Web Announcement 3915.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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. Pregnancy_Presumptive_Eligibility_Instructions.pdf
... coverage while beginning prenatal care immediately. Pregnancy presumptive eligibility is limited to one determination per pregnancy. Following the policy guidelines below, qualified entities (i.e., ...
Terms matched: 1  -  Score: 47  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Instructions.pdf
2. Pregnancy_Presumptive_Eligibility_Addendum.pdf
... Medicaid policy. 1.4 Limit PE determinations for pregnant individuals to no more than one per pregnancy. 1.5 Assist a minimum of 90% of the individuals determined presumptively ...
Terms matched: 1  -  Score: 21  -  15 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Pregnancy_Presumptive_Eligibility_Addendum.pdf
3. PT_34_Therapy_Tip_Sheet.pdf
... Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) ... includes a specific date range or times per week, the prior authorization request must ...
Terms matched: 2  -  Score: 55  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
4. FA-11.pdf
... request and is responsible for dissemination of all information regarding this request. "Units per day" multiplied by "Days per Week" multiplied by the total number ...
Terms matched: 1  -  Score: 66  -  07 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-11.pdf
5. Known_Issues.pdf
... codes that were • Once resolved, claims will be Crossover, updated per the 82nd Legislature Senate Bills 504 automatically reprocessed. Provider Types 24 & 439 ...
Terms matched: 1  -  Score: 356  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
6. Error_Code_to_EOB_to_ANSI.pdf
... Missing/Incomplete/Invalid prior Insurance CARRIER ON FILE COVERAGE CODE AND THE OTHER per coordination of benefits. Carrier(s ) EOB. PAYER PAID AMOUNT. ...
Terms matched: 1  -  Score: 377  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
7. NV_BillingGuidelines_PT11.pdf
... Billing Instructions for NICU • Nevada Medicaid will review NICU prior authorization requests per the table below effective with dates of service on or after January 1, ...
Terms matched: 1  -  Score: 77  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
8. NV_BillingGuidelines_PT11_online_082725.pdf
... Billing Instructions for NICU • Nevada Medicaid will review NICU prior authorization requests per the table below effective with dates of service on or after January 1, ...
Terms matched: 1  -  Score: 77  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
9. NV_BillingGuidelines_PT60_2025-1216.pdf
... amount. Vaccine claims are billed with the NDC and are limited to one vaccine per claim line and one unit of measure per individual product. Bill non-VFC vaccinations ...
Terms matched: 1  -  Score: 547  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
10. NV_BillingGuidelines_PT60.pdf
... amount. Vaccine claims are billed with the NDC and are limited to one vaccine per claim line and one unit of measure per individual product. Bill non-VFC vaccinations ...
Terms matched: 1  -  Score: 547  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
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